By checking this box, you agreed that I have requested that a reconditioned or new wheelchair provided to me by Chariots (the “Wheelchair”). While Chariots believes the Wheelchair to be in sound condition, it cannot represent or warranty that to be the case, and I agree, by signing this release, that I will not hold Chariots responsible for an injury as a result of any defect in the Wheelchair. Now, therefore, in consideration of Chariots’ provision of the Wheelchair to Me, the sufficiency of which consideration is acknowledged by Me, and intending to be legally bound, I agree as follows: I hereby release and forever discharge Chariots, its officers, directors, volunteers and their successors and assigns, from any and all “Claims” (as defined in Section 2 below) which I ever had, now has, or hereinafter can, shall or may have against Chariots, its officers, directors, volunteers and their successors and assigns arising out of, in connection with or because of, my use of the Wheelchair. For the purposes of this Release, the term “Claims” means claims, actions, causes of action, suits, debts, accountings, accounts, agreements, promises, damages, liabilities, and obligations of any nature, kind or description whatsoever, known or unknown, at law or in equity. This Release shall bind and inure to the benefit of each party and his or its respective executors, administrators, personal representatives, heirs, successors and assigns. The words "I" and "Me", together with any pronoun used in connection therewith in any form, shall include the singular, plural, masculine, feminine and neuter, as the context may require. Whenever used, the singular number shall include the plural and the plural the singular.
Date that you agreed to the above statement: