Name *

First Name

Last Name

Phone *

(###)

###

####

Date equipment will be picked up *

MM

DD

YYYY

Date equipment will be returned *

MM

DD

YYYY

Checkbox *

Adult Manikins

Infant manikins

AED Trainers

First Aid Packets each

10 # dive brick

Rescue Tubes

Back boards

BVM adult/infant set of 2

Face Shields set of 10

Reg Set*

BCD*

weight*

mask fin bootie snorkle rental *

Tank*

Dive computer*

Disclaimer *

Any equipment destroyed or damaged during the rental period is the responsibility of the individual/Company renting the equipment. The replacement cost will be a minimum of $200.00

Accept