1. I confirm that as far as I am aware I do not have any condition that would impair my ability to safely operate equipment provided to me by Shopmobility, or render my use of such equipment as a danger to others.

2. I promise to notify Shopmobility immediately in the event that I become aware of any changes in my condition which might affect my ability to safely operate any equipment loaned to me in the future.

3. I confirm that I am not on any medication that would impair me using the equipment loaned to me.

4. So far as I am aware, I have no uncorrected visual impairment that would affect my safe use of the equipment.

5. I confirm that as far as I am aware I do not suffer from uncontrolled Epilepsy.

6. I accept that any electrical vehicle loaned to me must be driven with due care and attention and manoeuvred at the appropriate speed, giving priority to pedestrians and not under the influence of alcoholic drink or illicit drugs.

7. If involved in any accident whether damage or injury is caused or not, I will report to Shopmobility staff as soon as possible.

8. I accept that no passengers of any age are to be carried on any of the vehicles loaned, other than the user and I am not to place shopping bags on the handlebars, or excessive baggage on the vehicle.

9. I accept that the vehicle is for the sole use of the member and is not to be used by any other person.

10. I accept that by using the equipment loaned to me I shall be liable for any damage, loss or repairs that may occur as a result of my negligence or misconduct.