Rental Equipment Waiver/Receipt 900802

Date ___________City of BlainePark and Recreation DepartmentRENTAL RECEIPT/WAIVERPLEASE READ BEFORE SIGNINGName________________________________Phone________________Address___________________________________________________City__________________ State_________ Zip___________________EQUIPMENT RATE QTY. HOURS TOTALCanoe $7.00/hr.Kayak $7.00/hr.Canoe 2 hr. Max. $14.00Kayak 2 hr. Max. $14.00Volleyball $2.00/hr.Late Fee ** $10.00OtherTotal Amount DuePRICES INCLUDE TAXTime Out/ In _________/__________ ____Cash ____Check Issued by _____Rental Agreement/WaiverI will be responsible for the replacement, at full retail value, of any equipment rented underthis Rental Agreement that is not returned to the rental location. I further agree to reimbursethe City of Blaine for any loss or damage, other than reasonable wear and tear, which resultsfrom the use of this equipment whether or not I am responsible for the loss or damage.I hereby agree that the use of the equipment under this Rental Agreement is undertaken bymyself at my sole risk and that the City of Blaine shall not be liable for any claims, demands,injuries, or damages, actions or causes of action, whatsoever to myself or property arising outof or connected with the use of any of the equipment under this Rental Agreement. I furtheragree to expressly release and discharge the City of Blaine from all such claims, demands,injuries, damages, actions or causes of action, and from all acts of active or passivenegligence on the part of the City of Blaine, its servants, agents or employees. I agree thatthis Rental Agreement was bargained for. In addition, I am aware that alternative servicesand products are available.I have made no misrepresentations to the City of Blaine, its servants, agents or employees, inregard to my age.Signature__________________________________________________________________Picture Identification required for deposit.Late fee is assessed when equipment is returned after agreed rented hours.