Shubert’s Kids Grant Application

Complete this section to substantiate and explain your need for devices.

I understand that approval of this request rests with Shubert’s Kids Fund Committee. For lawful purpose of publicity, illustration, advertising and web content, I consent to allow Shubert’s Kids and Dynamic Orthopedics to use name and photos of my child utilizing the orthotic or prosthetic.

By signing the application, the applicant and the applicant’s family declares that the family is in need, has no other means to obtain the devices that are medically necessary and will authorize release of any information to substantiate the request if necessary.

The applicant and the applicant’s family agree not to hold Shubert’s Kids or Dynamic Orthopedics liable for any defects, repairs, malfunctions or injury due to use of the services and product provided through this fund. (Refer to DOI warranty policy)

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Contact Us
6555 Nova Drive, Suite 306 Davie, FL 33317
Phone: (954) 424-1168
Fax: (954)-424-1884
info@dynamicorthopedics.com