Get up and GO! Request Form for Pilot Loan Program

Please submit the following Loan Request Form to request adaptive equipment. Requests can take up to one week to process. Please plan ahead and submit your request at least one week in advance.

Adaptive equipment available through this pilot program are:
Road cycles (hand/foot powered road trikes)
Straddleboard (Stand up Paddle Board with a center strut for sitting on)

Once you have submitted your request, an OAS staff member will follow up with next steps. Thank you!

We are starting this Pilot Loan Program with athletes in Central Oregon who have worked with OAS before. We hope to have a broader rental program in the future! 
First & Last Name *
Phone Number: *
What type of equipment are you looking to use? (please give as much detail as possible if make/model is unknown) We are offering trikes, recumbant trikes, hand powered trikes, foot powered trikes and straddleboards. *
Describe your experience with the requested equipment in the past: *
What other style of cycling equipment have you used? (select all that apply)
What is your level of experience with adaptive cycling equipment? *
What are your goals for cycling? *
Where do you plan to use equipment? *
What are your desired dates and duration? Please provide a couple of options in case the equipment is in use already. *
Never submit passwords through Google Forms.
This form was created inside of Oregon Adaptive Sports. Report Abuse