Common Contracts

Georgia Special Supplemental Nutrition Program for Women Infants and Children (WIC) Multi-User Electric Breast Pump Loan Agreement

January 19th, 2021

• Filed
  January 19th, 2021

District: Clinic: Loan Terms and ConditionsRead each statement, initial, and sign below:⎯ I have received instruction on the assembly, use, and cleaning of the pump. I understand how to use and clean the pump, and how to safely store my breast milk. Further, I agree to use the pump according to the instructions for assembly, use, and cleaning.⎯ I understand that this pump is the property of the Georgia WIC Program and is on loan to me. Therefore, I will not sell the pump, give it away, or let anyone else use it.⎯ I will keep the pump in a secure location at all times; and will report any loss or theft of the pump to the WIC Clinic.⎯ I will call my WIC Clinic if the pump is not working properly, if parts break, or it is otherwise damaged.⎯ I will not smoke around the pump.⎯ I agree that the pump I have been loaned by the WIC Clinic is clean and in good working condition.⎯ I will return the pump if I no longer need the pump; if I leave the state of Georgia; if I no longer maintain