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Equipment Loan Service Request Form

PLEASE NOTE: If required, please fill out additional forms if requesting more than four different types of equipment. Healthcare professionals requesting equipment for clients: Please complete the form using YOUR first and last name, and your contact info, and indicate the client's name and school in the 'Name of Organization or School" text line below 'Type of Organization/User'. If you have any questions, please contact the Para NB team at 1 (506)-462-9555 or 1-866-462-9555.

Region
Province
Please enter in the following format: (A1B 2C3)
Type of Organization/User
Are you making this request for use in physical education classes at a New Brunswick school?
New renter or returning (Have used ELS before)
Type of Equipment
(If you have nothing to add - write N/A)
This can be an estimate, used for planning purposes
How often do you intend to use the equipment?
How did you hear about the Equipment Loan Service?
Do you have a locked method of storage for the duration of your loan?
Would you like to be registered in the Para NB database so you may be contacted regarding sports and recreation opportunities in your region as they develop?
  • Yes please!
  • No thank you.
If yes, please enter the email you wish the e-newsletter to be sent to in the box below
I agree to these terms and conditions.
• Successful applicants will be required to execute an Equipment Loan Agreement in the form provided by Para NB. • Requests will be processed in the order they are received and equipment will be allocated according to program/individual needs, as prioritized by the Equipment Loan Service Coordinator. • Equipment can be picked up and dropped off in Fredericton (at our storage location: 55 MacKenzie Rd.) by appointment from Monday to Friday 8:30 am - 4:30 pm. • Where requested equipment is unavailable, the applicant will be notified within two working days and will remain on a waiting list.
  • Yes, I agree.
  • No, I do not agree.
Preferred Method of Contact
Preferred Language of Service
Is there anything else we should know while connecting with you? Let us know!
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