Impairment Goggles Program

Full Name:(Required)

First Last

Organization/School:(Required)

Address:(Required)

Street Address City State ZIP / Postal Code

Phone Number:(Required)

Email Address:(Required)

Request Rental Start Date(s):

Recommended: Please provide at least two available dates, a week apart, to help facilitate scheduling.

1. Loan Period: Equipment is loaned for one (1) week from the Start Date listed above. Extentions available by request.
2. Condition: Borrower agrees to return the equipment in the same condition it was provided, normal wear and tear excepted.
3. Damage/Loss: Borrower is financially responsible for any damage or loss of equipment during the loan period.
4. Liability: The Borrower assumes all responsibility for use and care of the equipment.
5. Disclaimer of Liability: The Borrower acknowledges and agrees that the Lender (ISLD) shall not be held liable for any injury, loss, damage, or accident incurred while the equipment is in the Borrower's possession or use. The Borrower assumes full responsibility and risk for the use of the equipment and agrees to indemnify and hold harmless the Lender, its employees, agents, and affiliates from any and all claims, damages, or expenses arising from such use.

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