Rental Release Agreement - READ ONLY

ATTENTION: By signing this document you will waive or give up certain legal rights, including the right to sue or claim compensation following an accident or during normal usage of this rental wheelchair

Rental Release Agreement - READ ONLY

  • MEDICAL CONDITIONS:

  • I understand that a cognitive disability or medical condition could affect my capabilities of operating a folding electric wheelchair. This folding electric wheelchair is intended to be used only by those persons who are able to operate the chair, and who are able to control their driving behavior and braking distance to suit the weather, visibility, surrounding environment, pedestrians and traffic conditions.

    I understand that I am responsible to cover the costs of any injury that may arise while driving or operating a folding electric wheelchair, and I agree to bear the costs of such injury and or medical rescue evacuation myself. I acknowledge that in the event of an accident, that medical assistance may not be immediately available in my area. I further certify that I am willing to assume the risk of any medical or physical conditions I may have.

  • DAMAGES:

  • I understand that I am responsible for any NEW DAMAGES to the folding electric wheelchair while renting. It is my responsibility to notify FOLD &GO WHEELCHAIRS® of those new damages. By signing this agreement, I am agreeing to pay for all NEW DAMAGES caused to the folding electric wheelchair while in my possession.

  • RELEASE OF LIABILITY WAIVER OF CLAIMS:

  • 1. I AGREE TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against FOLD & GO WHEELCHAIRS® AND TO RELEASE FOLD & GO WHEELCHAIRS® from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer, as a result of using the folding electric wheelchair.

    2. I AGREE TO HOLD HARMLESS AND INDEMNIFY FOLD & GO WHEELCHAIRS® from any and all liability for any property damage or personal injury to any third party resulting from my use of the folding electric wheelchair;

    3. This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity;

    4. This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the United States.

    5. Any litigation involving the parties to this Release Agreement shall be brought solely within the United States and shall be with the exclusive jurisdiction of the courts of the United States.

  • SIGNATURE:

  • I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT PRIOR TO SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS RELEASE AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXCUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST FOLD & GO WHEELCHAIRS®.
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