🦺Personal Flotation Device Loan Form🦺

🦺Personal Flotation Device Loan Agreement🦺

In Cooperation with Columbia Basin Dive Rescue and Safe Kids Coalition
Benton County Fire District #4 (“District”), in cooperation with Columbia Basin Dive Rescue and Safe Kids Coalition, provides personal flotation devices (PFDs) for temporary use. By accepting a PFD, the borrower agrees to the terms below.
LOANED EQUIPMENT

Personal Flotation Devices

Rows	Quantity
Infant - Less than30 lbs
Child - 30-50 lbs
Youth - 50-90 lbs
Youth/Adult - 90+ lbs
Adult Small
Adult Medium
Adult Large
Adult X-Large

Number of PFD's Loaned
Date Issued

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Expected Return Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
BORROWER'S RESPONSIBILITIES
- Select and use a PFD appropriate for the user’s size, weight, and intended activity.
- Ensure each PFD is properly fitted, secured, and worn as directed by the manufacturer.
- Inspect the PFD before use and immediately discontinue use if it appears damaged, defective, or otherwise unsafe.
- Follow all applicable laws, regulations, manufacturer instructions, and water-safety practices.
- Provide appropriate supervision of children and other users who may require assistance.
- Return all PFDs to the District in substantially the same condition in which they were received, ordinary wear excepted.
- Immediately notify the District of any loss, damage, defect, or malfunction involving a borrowed PFD.
The borrower understands that a PFD is a safety device and does not guarantee the prevention of injury or drowning.
ASSUMPTION OF RISK
The borrower understands that participation in or around water involves inherent risks, including but not limited to drowning, injury, illness, adverse weather, cold water, currents, waves, falls, and other hazards.

The borrower voluntarily accepts responsibility for the safe use of the borrowed PFD and assumes the risks associated with its use, except to the extent caused by the intentional or negligent act or omission of Benton County Fire District #4, Columbia Basin Dive Rescue, or Safe Kids Coalition.
LIABILITY AND INDEMNIFICATION
To the fullest extent permitted by law, the borrower agrees to defend, indemnify, and hold harmless Benton County Fire District #4, Columbia Basin Dive Rescue, and Safe Kids Coalition, and their respective officers, employees, agents, and representatives, from claims, damages, losses, liabilities, and reasonable expenses, including attorney’s fees, arising out of or related to the borrower’s use, misuse, or possession of the PFD, except to the extent caused by the intentional or negligent act or omission of Benton County Fire District #4, Columbia Basin Dive Rescue, or Safe Kids Coalition.

Where liability arises from the concurrent negligence of the District, Columbia Basin Dive Rescue, Safe Kids Coalition, and the borrower, the borrower’s obligation under this section shall apply only to the extent of the borrower’s negligence.

The borrower is responsible for loss of or damage to District property caused by the borrower or persons using the PFDs under the borrower’s responsibility, except for ordinary wear and tear.
BORROWER INFORMATION
Borrower's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
ACKNOWLEDGEMENT AND SIGNATURE
By signing below, I acknowledge that I have read and understand this agreement. I understand my responsibilities regarding the selection, fitting, use, supervision, care, and return of the PFD(s) loaned to me. I voluntarily agree to the terms of this Personal Flotation Device Loan Agreement.
Borrower's Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Name (if borrower is under 18):

First NameLast Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
- Issued By
  
  First NameLast Name
- Date Issued
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Checked-In By
  
  First NameLast Name
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Notes
- Should be Empty:

🦺Personal Flotation Device Loan Agreement🦺

LOANED EQUIPMENT

BORROWER'S RESPONSIBILITIES

ASSUMPTION OF RISK

LIABILITY AND INDEMNIFICATION

BORROWER INFORMATION

ACKNOWLEDGEMENT AND SIGNATURE