Kauai Wheelchair Agreement & Waiver Forms


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.




Release of Liability Form
Adobe Acrobat document [65.1 KB]
Kauai Wheelchair Rental Agreement
Kauai Wheelchair Rental Agreement.pdf
Adobe Acrobat document [69.8 KB]
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