TRAINING MATERIALS REQUEST

RI DMAT/MRC - NOPE-RI
Agreement to Borrow Training Materials
Release of Liability

Please fill out this form to request overdose prevention training materials for your organization. If you have any questions, please email aengelman@riresponds.org

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    Agreement to Borrow Training Materials and Release of Liability

    I, (NAME), am renting the following training materials (the “Training Materials”) from RI DMAT, a 501(c)3 not-for-profit organization:
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    Intramuscular (IM) Training Kit

    - 2 naloxone vials, 0.4mg/1mL (IM dose) - 2 syringes, 3cc with needle - oranges (not provided)
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    Intranasal (IN) Training Kit

    - 2 naloxone prefilled syringes, 2mg/2mL (IN dose) - 2 MAD nasal atomizers
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    Rescue Breathing Training Kit

    - 2 adult manikins with disposable lungs (infant manikin available on request) - 25 alcohol preps (disposable, please return unused items)
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    The rental period for my Training Materials is from (START DATE) to (END DATE). I understand that it is my responsibility to pick up the Training Materials, and to return them to the same location at the end of my rental period unless otherwise agreed by both parties. I agree to return the Training Materials to RI DMAT in the same condition that it was in on the day I rented it.

    I understand that there is no charge for the rental of the Training Materials. However, in the event that the Training Materials are lost or destroyed during my rental period, I agree to replace the Training Materials at my own expense. Also, if the Training Materials is damaged, beyond normal wear and tear, during my rental period, I agree to have the Training Materials fixed or replaced. I understand that RI DMAT is not warranting that the Training Materials are fit for use for any particular training, and that I am solely responsible for the selection of the Training Materials. I have consulted with appropriate authorities and experts in the in the selection of the Training Materials and I have received training in their proper use. I HEREBY RELEASE FROM LIABILITY AND AGREE TO INDEMNIFY AND HOLD HARMLESS RI DMAT, AND ANY OF ITS EMPLOYEES, AGENTS OR VOLUNTEERS REPRESENTING OR RELATED TO RI DMAT, RI MRC, AND NOPE-RI, FOR ANY LIABILITY IN CONNECTION WITH THE USE OR POSSESSION OF THE TRAINING MATERIALS. THIS RELEASE IS FOR ANY AND ALL LIABILITY FOR PERSONAL INJURIES (INCLUDING DEATH) AND PROPERTY LOSSES OR DAMAGE OCCASIONED BY, OR IN CONNECTION WITH THE POSSESSION OR USE OF THE TRAINING MATERIALS.
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