Medical Equipment Inquiry

RECIPIENT AGREEMENTS & ACKNOWLEDGMENTS
I understand that submitting this form does not guarantee that my family will receive equipment from From We Can’t to We Can. I acknowledge that equipment availability depends on donations, condition of items, safety standards, and organizational capacity. I understand that From We Can’t to We Can will make every reasonable effort to donate, match, or connect my family with appropriate equipment when possible, but availability is not guaranteed.*

I understand and agree.
I confirm that this equipment request is based on a recommendation from a licensed medical professional, such as a physician, physical therapist (PT), or occupational therapist (OT).I understand that From We Can’t to We Can is not a medical provider and does not determine medical appropriateness of equipment.I agree that it is my responsibility to consult with my child’s doctor, therapist, or medical team to ensure that any equipment received is safe, appropriate, and properly fitted for my child.*

I confirm and agree.
Acceptance of Equipment “As Is”: I understand that all medical equipment provided by From We Can’t to We Can is donated by third parties and is provided “AS IS.” I acknowledge that: The equipment may be used, refurbished, or pre-owned. From We Can’t to We Can makes no warranties or guarantees, express or implied, regarding the condition, safety, or suitability of the equipment. It is my responsibility to inspect the equipment and ensure it meets my child’s needs prior to use.*

I understand and agree to accept the equipment as is.
Assumption of Risk & Hold Harmless Agreement: I acknowledge that the use of medical equipment carries inherent risks, including but not limited to injury, malfunction, or misuse. I voluntarily assume all risks associated with the use of the equipment on behalf of myself and my child. I agree to release, indemnify, and hold harmless From We Can’t to We Can, its board members, staff, volunteers, partners, donors, and affiliates from any and all claims, damages, injuries, or liabilities arising from the use, misuse, or condition of the equipment provided.*

I agree to the Hold Harmless and Assumption of Risk terms.
I understand that by accepting equipment through this program, I waive my right to bring legal action, claims, or lawsuits against From We Can’t to We Can related to the donated equipment, its condition, or its use.*

I understand and agree.
I understand that: The equipment is provided for my child’s use only. I may not sell, rent, or profit from this equipment. If my child no longer needs the equipment, I agree to return it to From We Can’t to We Can so it can support another family.*

I agree to use and return the equipment as stated.
Photo & Media Permission: I grant permission for From We Can’t to We Can to photograph or film my child using the donated equipment for nonprofit purposes, including but not limited to social media, website content, reports to donors, and promotional materials.*

Yes, I grant photo/video permissionNo, I do not grant permission (this will not affect receipt of equipment)
I understand that acceptance of this equipment is connected to my family’s From We Can’t to We Can Member ID, and that misuse of equipment or violation of these agreements may result in temporary or permanent ineligibility for future resources.*

I understand and agree.
By typing my name below, I confirm that I have read, understood, and agreed to all terms above. I acknowledge that this electronic signature is legally binding. Parent/Guardian Full Legal Name:*
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Medical Equipment Inquiry

RECIPIENT AGREEMENTS & ACKNOWLEDGMENTS