HAND RECEIPT FOR SAPC EQUIPMENT

RELEASE OF LIABILITY

I__________________________________ acknowledge receipt

of the following items of SAPC loaner equipment:

____________________________________ -List 1 item per line

____________________________________ -X through all

____________________________________ unused lines

____________________________________

____________________________________

____________________________________

I agree to be responsible' for the above equipment and repair or

replace any lost or damaged equipment above and beyond normal

wear and tear. Further I will replace any items used from the first

aid kit. Also I will return items in a clean and dry condition and

will sterilize the toilet if used.

SAPC makes no claims as to the performance or correct use of the

loaner equipment. SAPC will not be responsible for any

consequential or incidental damages caused by or resulting from

the use or performance of SAPC loaner equipment. I agree to

release SAPC and all club members from any and all liability

resulting from the use of this equipment.

I plan to return the equipment by ________________________.

(date)

Printed Name: __________________________

Signature: _________________________ Date: ____________

Items Returned OK and clean: _________ Date: ____________

(Initials)