PLEASE NOTE: All 2023 Equipment Request Forms must be submitted by Friday 12/8/23.
(To be completed by an OT, OTA, PT, PTA, SLP, Licensed Physician, OR Cuyahoga DD Staff)
The following release must be signed by the parent/guardian before NEON is able to process the request for equipment
Cuyahoga DD - Release of Liability Waiver for Family Support Services: Installation and/or Assembly of Sensory Equipment
I acknowledge that I am responsible for the installation and/or assembly of the equipment requested from Cuyahoga County Board of DD.
I hereby agree to indemnify and hold harmless the Cuyahoga County Board of Developmental Disabilities and its employees or agents from and against any and all claims, suits, damages, or causes of action resulting in whole or part, directly or indirectly, from my installation and/or assembly of Cuyahoga DD Family Supports Funded Equipment at my residence, and against any orders or decrees or judgments which may be entered therein, brought for damages or alleged damages, resulting from any injury to person and/or property or loss of life sustained by any person or persons whatever.