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Medical Equipment Form

PLEASE CALL OUR OFFICE BEFORE COMING TO OUR SITE FOR MEDICAL EQUIPMENT TO ENSURE WE HAVE IT AVAILABLE.

THANK YOU.

MEDICAL EQUIPMENT LOAN
Release and Hold Harmless
In consideration of being allowed to use certain medical equipment from the Pawling Resource
Center I agree as follows:


That the equipment being loaned to me has not been professionally examined or inspected,
therefore it is being loaned to me in “as is” condition and I hereby assume the risk of loss or
personal injury or property damage resulting from its use.

I, (as well as my heirs, executors, and assigns) do release, indemnify and forever discharge and
hold harmless, the Pawling Resource Center (and its agents, officers, employees and assigns),
from any and all liability, loss or damage whatsoever, arising from use or possession of this
equipment.
I agree to use this equipment only for the purposes for which it is intended.

IN WITNESS WHEREOF, I have hereunto set my hand(s) and seal(s) this
You will be required to sign this form before borrowing equipment.

In consideration of being allowed to use certain medical equipment from the Pawling Resource Center I agree as follows: That the equipment being loaned to me has not been professionally examined or inspected, therefore it is being loaned to me in “as is” condition and I hereby assume the risk of loss or personal or personal injury or property damage resulting from its use. I, (as well as my heirs, executors, and assigns) do release, indemnify and forever discharge and hold harmless, the Pawling Resource Center (and its agents, officers, employees and assigns), from any and all liability, loss or damage whatsoever, arising from use or possession of this equipment. I agree to use this equipment only for the purposes for which it is intended. By typing your name below you acknowledge that you understood this statement and will abide by it.