Langley Pos-Abilities Society

"changing disabilities into possibilities"

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You are here: Home / Personal Assistive Devices / Personal Assistive Device Donation Form

Personal Assistive Device Donation Form



COVID-19 Notice:

Please read our current Announcement for Personal Assistive Device Request/Donations here before submitting this Personal Assistive Device Donation form.

To donate a personal assistive device, please use this form.

NOTE: Before clicking "Submit" please be sure you have filled out ALL fields marked with a red *


If you do not see the "Thank You" page after clicking the Submit button, please check the form to make sure you have filled in ALL required fields.

If you would rather fill out a printed form, please download/print this PDF form and send it to us.
  • PLEASE NOTE: Your donation form must be accompanied by a current picture(s) of the piece(s) of equipment being donated, so we can determine whether we are able to accept it.

    If you wish to receive an income tax receipt for your donation, it must be accompanied by a written evaluation from a reputable dealer.
  • MM slash DD slash YYYY
  • Please give us as many details as possible, eg. “Powerchair for tall heavy adult, needs new battery”, or “Scooter in nearly new condition for small adult; has carrier basket and sunshade”. We will be contacting you to arrange for pick up.
  • Max. total file size = 2Mb
    Drop files here or
    Accepted file types: jpg, gif, png, Max. file size: 2 MB.
    • We take your privacy very seriously. Your information is not shared with any other agency or organization without your written consent.
    • This field is for validation purposes and should be left unchanged.

    Welcome to Langley Pos-Abilities Society

    Langley Pos-Abilities Society is a non-profit volunteer supported agency that helps improve the quality of life for people with disabilities, including those living with mobility issues, hearing loss, blindness, plus many other conditions requiring assistive devices. Read More

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