Kauai Wheelchair Agreement & Waiver Forms

Aloha!

We can have your rental and agreements forms ready when you pick up your equipment. Please ensure that we have the following information in advance with your reservation:

Users Name:

Contact telephone:

Home address:

Kauai Vacation Address:

Equipment Type: 

Rental Period Time & Date:

Pick Up or Delivery Time:

Return Time:

Payment __Cash or __Credit Card

For safety reasons, A1 Lift or Kauai Wheelchair members are not permitted to assist equipment users into or out of wheelchairs or scooters. They are also prohibited in providing assistance with swimming, dressing, toileting, or other tasks. Thank you for your understanding.

Mahalo's