Beach Wheelchair Booking Form

Beach Access Wheelchair
A Ute or trailer is needed for collecting and transporting the chair to a different site. Surf Lifesaving Tas may be able to transport the chair to various beach sites. They are open to possibilities and will explore with you. A hire form needs to be filled out on pick up. Hire is FREE, there are no charges.
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Requested Pick Up Date*

DayMonthYear
Date
Requested Drop Off Date*

MonthDayYear
Date
Upload Drivers License*

Cancelof
Pick Up Location*

SLST State Office, 100 Mornington Road, Mornington 7018 (South)SLST Sandy Bay Lifeguard Service, Long Beach, Sandy Bay (South)Bicheno Surf Life Saving Club (South)Kingston Surf Life Saving Club (South)Port Sorell Surf Life Saving Club (North West)Ulverstone Surf Life Saving Club (North West)Somerset Surf Life Saving Club (North West)Devonport Surf Life Saving Club (North West) – Council OwnedBurnie Surf Life Saving Club (North West) – Council OwnedBridport Surf Life Saving Club (North) – Launceston Area
CONDITIONS FOR LOAN OF BEACH WHEELCHAIR (BWC)• I agree to use the BWC in accordance with the written instructions provided. • I acknowledge SLSA makes no warranties as to the BWC and its fitness for purpose. • I understand the BWC should not be taken into water to a depth greater than 25cm. • Before using I agree to check that all lynch pins and bolts in the BWC are in place. • After each use I agree to rinse the BWC in fresh water. • I understand the user assumes all risk of injury due to use of the BWC. Surf Life Saving Tasmania Inc (SLST) accepts no liability to the extent permitted by law. I indemnify and will keep indemnified SLST in respect to any claims that may be made by any person arising from use of the BWC. • I will return the BWC to SLST to the location from where it was taken by the due date set out above. • I agree to borrow/hire the BWC under the conditions listed above. I have read and acknowledge that I understand the above conditions of loan.*

Yes Agree
Special Requests
Should be Empty:

Beach Access Wheelchair