Equipment Checkout Form

Equipment Checkout Form

Sports Chair
Date

MonthDayYear
Date
Athlete Name

First NameLast Name
Parents Name if under the age of 18

First NameLast Name
Email
example@example.com
Phone Number
Checked Out Equipment

Sports Wheel ChairOther
Wheelchair Brand
Color
By signing below, the athlete/family takes the responsibility for any kind of damage to checked out equipment and acknowledges that the equipment is working properly and in a good condition. For any loss or damage, the athlete/family accepts to cover the cost of new equipment up to $3,000.
Signature

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