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Secondary Technology Check Out Form
(Staff) Fill out the following and return it to the Secondary Technology Teacher in room F6. Person who wishes to check out technology equipment: ____________________ (1st Name & Last) Reason for the request: _____________________________________________ Dates the equipment is needed: From:________________ To: ______________ Equipment and Related Materials: ______________________________________ __________________________________________________________________ __________________________________________________________________ Terms and Conditions: The technology equipment will be used in a manner that is consistent with mature common sense. It is the borrower’s responsibility to check and see that all of the equipment is functioning properly before check-out. In the case where the equipment is not functioning properly, the borrower will note any problems on the back of this form before checking out the equipment. The equipment must be treated with care and the borrower of the equipment assumes full responsibility in the case of theft, loss, damage, or other harm to any part of the equipment. The equipment must be returned not more than one day from the final date listed above. If the Secondary Technology Teacher is unavailable to receive the equipment, it is the borrower's responsibility to store the equipment in a secure area and inform the Secondary Technology Teacher of equipment's whereabouts. I, ______________________________, have read the Terms and Conditions for use of secondary technology resources at ASA. I understand and will abide by these regulations. Should I not comply with the aforementioned responsibilities, I understand that my equipment access privileges may be limited or revoked, I may be fined, and/or I may be required to pay for damaged, lost, or stolen equipment. Staff Signature:__________________________ Date:________________________________ |