Inflatables Chain of Custody Form

Completed by both the releasing and receiving parties whenever an MD4 inflatable transfers from one District to another.

Step 1

Inflatable & Transfer Details

Inflatable # *

Date of Transfer *

Step 2

Releasing District

First Name *

Last Name *

Email *

Phone Number *

Releasing Club Name *

Releasing District *

I AFFIRM the inflatable kit is complete, clean, in good working order, and has been properly stored the entire time. (optional)

Step 3 · Optional

Courier Transfer

Only complete this section if a driver is temporarily picking up the kit on behalf of the requesting district.

Driver's Name

Phone Number

Email Address

Tentative Transfer Date to Requesting District

Step 4

Receiving Party

First Name *

Last Name *

Email *

Phone Number *

Receiving Club Name *

Receiving District *

Temporary RELEASE to driver (transferring between districts only) (optional)

I AFFIRM the inflatable equipment kit IS complete, clean, damage free, and appears to be in good working order. (optional)

Step 5

Storage After Event

First Name *

Last Name *

Phone Number *

Email Address *

Street Address *

Address Line 2

City *

State

Zip Code *

Approximate Storage Duration

Kit Contents — Keep These Items Together

Main inflatable
Blower
Leo velcro panel (backside)
3 velcro soccer balls
String tie-downs
Vinyl transport bags
Velcro soccer dart panel

Please confirm all items are present and accounted for before the receiving party departs with the kit.

Both parties agree that the receiving party is now responsible for storing, caring for, and cleaning the inflatable kit, and agrees to reimburse MD4 for any loss or damage. *

Optional

Questions or Comments

A confirmation will be sent to both parties' emails on file. Please keep a copy of this record for your club's files.