Quincy Helping Hand
Helping Hand provides free donated equipment, such as wheelchairs, canes, commodes, special bathroom equipment, and walkers to those whom otherwise would not be able to afford it. Use this form to request equipment and my office will contact you soon with more information. For more information, please call (617) 328-0102, or email me at brucej.ayers@yahoo.com.
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Full Name *
Email *
Address (Street, City,  State, Zip) *
Telephone Number *
Equipment Requested *
Required
Borrowing on behalf of: *
Other questions, comments or concerns?
Participation Agreement & Waiver
I hereby state that I am voluntarily participating in the Quincy Helping Hand Program, an in-kind loan closet of durable medical equipment sponsored by State Representative Bruce Ayers.

I hereby assume all risk of personal injury, death, property damage or loss that may arise from the use of this equipment. I hereby release the sponsor; Ayers Handicap Conversion Center Inc.; C.W. Ayers Inc; and any officers, agents, and/or employees of said entities from any liability arising from my use of this equipment. I understand these entities bear no obligations to inspect, repair, pay for, pick up, or deliver equipment.

I assume all responsibility for the equipment while it is under my control, and agree to have any equipment I donate and/or return inspected beforehand. I will return the equipment as I no longer need it.
Participation Agreement & Waiver *
Required
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