WCN Equipment Use Request Form

WCN Equipment Use Request Form
Name*

First NameLast Name
Organization Name
If applicable
E-mail*
Contact Number*

Area CodePhone Number

Equipment*
Please be as specific as possible when listing items. Including size, color, quantity, etc.
Date of Pick Up*

MonthDayYear
Date
Time of Pick Up*

:HourMinutesAM/PM Option
Date of Return*

MonthDayYear
Date
Time of Return*

:HourMinutesAM/PM Option
Additional Requests

Liability Agreement

Please sign below.
I understand that it is my responsibility to pick up the equipment from the church office once the request has been approved. I understand that it is my responsibility to return the borrowed item(s) to the church office within 24 hours of borrowing item(s) unless otherwise agreed upon by the church office.

I agree to return the equipment to staff of the West Chester Nazarene (WCN) in the same condition that it was received in when I borrowed it.

I understand that there is no charge for use of the equipment. However, in the
event that the equipment is lost or destroyed while in my possession, I agree to cover any and all costs associated with the replacement of the lost/damaged equipment.

I understand that the West Chester Nazarene is not warranting that the equipment is fit for use or for any particular person, and that I am solely responsible for the selection of the equipment. I understand that WCN may provide limited assistance with equipment supplied.

I HEREBY RELEASE FROM LIABILITY AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE WEST CHESTER NAZARENE, AND ANY OF ITS EMPLOYEES FOR ANY LIABILITY IN CONNECTION WITH THE USE OR POSSESSION OF THE EQUIPMENT. THIS RELEASE IS FOR ANY AND ALL LIABILITY FOR PERSONAL INJURIES AND PROPERTY LOSSES OR DAMAGE IN CONNECTION WITH THE POSSESSION OR USE OF THE EQUIPMENT.
Signature*

Clear
Print Name*
Date*

MonthDayYear
Date
Should be Empty: