Life Jacket Loaner Program Award Signature Form

Life Jacket Award Signature Form

2024 Terms & Conditions E-SIGNATURE FORM - LIFE JACKETS

This form must be submitted by April 15, 2024. Grant awards will not be shipped until the e-signature form is received. Failure to respond by the deadline will deem your group ineligible to receive any grant awarded life jackets and they will be offered to other groups starting on April 16, 2024.

Grant award decision letters were emailed to the grant applicant email address. You must read the Life Jacket Terms & Conditions before signing below. Please take the time to read through as it includes details about the required reporting to comply with the grant. Save or print for future reference. You will need to refer to the grant award email to fill out the form below. The Life Jacket Terms & Conditions contain complete details of the following requirements:

Submit 4 Monthly Count Reports for June, July, August and September using this link.
Submit 1 Life Jacket Program Final Report by October 15, 2024 using this link.
Submit 1 One-year Life Jacket Program Report by July 30, 2025 at a link to be emailed by the end of the summer.
Provide locations and phone number(s) so the general public can access the life jackets.
Make arrangements to accept any donated life jackets that are in serviceable condition to replenish the supply.
Properly prepare and maintain the life jackets.
Do not give away, list as prizes or incentives or sell any grant-funded life jackets.
Contact Sea Tow Foundation immediately if any life jackets are credited with saving a life.
Request prior approval to add logos or information to Sea Tow Foundation signage.
Notify Sea Tow Foundation of any group, contact or location changes.
Return all life jackets to the Sea Tow Foundation if your loaner program closes.
Utilize the Press Release Template.
Secure approval of the Loaner Station location if required.

If you have any questions please reach out to Kim Perry at kperry@seatow.com.

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GROUP INFORMATION
Foundation Group ID (XXXX-XXXXX) *This can be found in the award email. Enter all letters, the dash, and numbers.
Group Name *
First Name *
Last Name *
Phone (123-456-7890) *This phone number should be the best contact number for your program and will be visible on our online map.
Email Address *
Main Email for group if differentPlease provide a generic email address for your group or an alternate name and email address in the boxes below in case the primary contact changes.
Alternate Contact Name
AlternateContact Email

SHIPPING INFORMATION FOR LIFE JACKETS
Address Line 1 *Shipments can't go to PO Boxes
Address Line 2
City *
State *		Zip/Postal Code *
Delivery InstructionsProvide any other details about delivery in this section.
HOW MANY LIFE JACKETS ARE YOU AWARDED?Refer to the grant award letter that was emailed to your group to fill in how many life jackets of each size and total life jackets you are receiving from the 2024 Sea Tow Foundation Grant?
Infant *
Child *
Youth *
Adult *
Adult XL *
Total Life Jackets Awarded *
HOW MANY LIFE JACKETS IN YOUR INVENTORY?Including the new grant-funded life jackets above, how many total life jackets does your group currently have in your life jacket loaner program, including all loaner stations and storage?
Infant Life Jackets *
Child Life Jackets *
Youth Life Jackets *
Adult Life Jackets *
Adult XL Life Jackets *
Total Life Jackets in Inventory *
What is the location name of the station where these life jackets will be placed?If the life jackets will be placed in more than 1 station please complete this form https://www.boatingsafety.com/page/StationLocations
Latitude Coordinates in decimal degrees (DDD.DDDD) *To find GPS coordinates using Google Maps: -Go to the satellite view -Zoom in to the location where your loaner station will be, then right-click. The coordinates will be on the top line. -Tap on the latitude and longitude coordinates and they will be copied to your computer clipboard. Copying and pasting from Google maps may not work. Try typing in the coordinates directly.
Longitude Coordinates in decimal degrees (-DDD.DDDD) *
How many loaner stations do you manage in your program? *
How many Sea Tow Foundation grant-funded loaner stands does your group use? *
____________________________________________________

ELECTRONIC SIGNATURE
On behalf of my organization, I have read and agree to abide by the Sea Tow Foundation’s 2024 Life Jacket Terms & Conditions for Award of Life Jackets. I also verify that my organization can enter into this agreement with the Sea Tow Foundation in order to carry out a life jacket loaner program. I am aware that the life jackets and signage displayed on the loaner stand will carry the Sea Tow Foundation logo as well as the Sport Fish Restoration and Boating Trust Fund logo signifying that the life jackets were purchased with federal grant funds. I have signing authority for the organization receiving the life jackets. I also understand that failure to comply with these requirements will result in not being eligible to receive life jackets and/or loaner stand kits from the Sea Tow Foundation in future years. In addition, I understand that a report will be filed with the U.S. Coast Guard detailing the results of this grant project and that a negative report reflecting improper actions by a participating organization could negatively impact that organization’s ability to receive federal grant funding in the future. By selecting “I Accept” and e-signing this form, using any device, means or action, I consent to the legally binding Terms and Conditions and that my electronic signature (e-signature) by entering my name on this form and submitting to Sea Tow Foundation is valid and binding.
Did you read the 2024 Life Jacket Terms & Conditions? *	Yes No
I accept the 2024 Terms & Conditions for Award of Life Jackets *	I Accept I Do Not Accept
E-Signature - type name *

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2024 Terms & Conditions E-SIGNATURE FORM - LIFE JACKETS