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Lakeland Bank Presents Rock the Dock on May 18th, Register now!

Apply to Join

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How to Apply

We’re glad you’re interested in Push to Walk! Please review and complete one of the forms below. Select the diagnosis category that is the closest match to your condition, then the format of the form you prefer (PDF or Microsoft Word document).

Prior to your initial evaluation, your application and physician’s clearance must be sent to Push to Walk. Send these by fax to 201-644-7568 or email them to kwolfe@pushtowalknj.org.

Application and Required Forms

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Brain Injury/CP/Stroke/Other

Client Responsibilities

All clients must be independent of a ventilator. Clients must be able to maintain their appointments on a consistent basis, have reliable transportation, and the financial ability to pay the hourly fee of $115. Scholarship funds are available to individuals who qualify.

Not sure?

Find out if Push to Walk is right for you.

If you’re not sure whether or not you’re a good candidate for Push to Walk, please complete the form below and a Push to Walk team member will get back to you to answer your questions.