Please fill out the form below. If you have any questions please email lowell@kaylas.org.

Child's Name(Required)
MM slash DD slash YYYY
Parent Contact Name(Required)
Does your child have any of the following? If so, they may not be eligible for the Trexo. Our therapist will contact you.(Required)
We have a large size Trexo. Please measure your child's legs so we can have an approximate sense of if they will fit, using the picture below as a guide.