Equipment Loan Agreement

Equipment Loan Agreement

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Name*

Email Address*

Phone Number*

Address*

Where will the chair be stored?

Type of chair*

Wheelchair Rugby; Wheelchair Basketball/Allcourt/Wheelchair Tennis or Wheelchair Track

Will the chair be stored securely?*

Provide details of where it will be stored.

Please note and acknowledge that if the chair is lost or damaged beyond repair, replacement will fall on the hirer.*

Yes

Partners

Transport for NSW

Mogo Wheelchairs

Stacks Goudkamp

Freedom Motors Australia

Forward Ability

Independent Mobility & Rehab

Cauliflower Club

NSW Australia Day Council

Charity Challenge

Stuart Alexander

Blacktown City Council

We Support

Pride in Sport

Play By The Rules