Equipment Rental

Manikin & Equipment Rental

Request Form

Instructor Information

* Indicates required field

Instructor Name *

First

Last

Training Site / Location *

Phone Number *

Email *

Rental Information

Training Date *

Length of rental (DAYS) *

Pickup Date *

Course Type *

Location *

Number of Students *

Rental Information

Adult Manikins ($25.00 Each) *

Infant Manikin ($25.00 Each) *

AED Trainer ($30.00 Each) *

Cardiac Minitor / Tablet *

Training Valves ( Pack of 10 $20.00) *

Adult BVM ($5.00 Each) *

Infant BVM ($5.00 Each) *

Laptop / Projector / Speakers ($65.00 Each) *

Wrist Watch Compression Monitor ($7.00 Each) *

Order Total: *

* Equipment must be picked up and returned by the requesting instructor during normal business hours.

Equipment rental request must be made at least 3 days prior to pickup date. Other RUSH request will be charged a $50.00 fee.

* Requesting instructors will be held responsible for all damaged or missing equipment.
* All rentals and fees are per day equipment not returned on time will accrue an additional day rental charge plus a $50.00 per day late return fee.

* Learn CPR NYC Inc.is not liable for any injury or damages that occur while equipment is in possession of the requesting instructor.
* Payment and/or authorized processing payment form must be received before request can be approved.
* A $200.00 credit card hold must be placed on rentals that exceed $400.00.

I have read and agree to the above terms and conditions *

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Comment / Request *

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Manikin & Equipment Rental​Request Form

Manikin & Equipment Rental

Request Form