(please read and type signature when prompted)
This agreement is a release of the recipient’s rights to sue for injuries or death resulting from the loaned equipment. Recipient expressly assumes all risks related in any way to the use of this loaned equipment. Equipment will be loaned at no charge and should be returned by recipient clean and in good condition when no longer needed. Recipient acknowledges that the equipment is in good working condition and that he/she has examined the equipment to inspect its condition and identify any defects. Any damage or replacements are to be made at the expense of the recipient and not St. Louis HELP. Recipient also understands that St. Lous HELP, and its employees, officers, volunteers or agents (hereinafter “Released Parties”), shall not be held liable or responsible in any way for injury, death or other damages to recipient or his/her family, heirs or assigns which may occur as a result of the loaned equipment or as a result of product defect, or the negligence of any party, including the Released Parties, whether passive or active.
I have carefully read and understand the above agreement. By signing this agreement, I exempt and release St. Louis Health Equipment Lending Program, a nonprofit, from all liability and responsibility whatsoever for personal injury, property damage, or wrongful death as a result of receiving equipment, however caused, included, but not limited to product liability or negligence of the released parties, whether passive or active.