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Trevor -Wilmot Consolidated Grade School District

Use of School Equipment Application

1. School: ___________________________________________________________________

2. Date of Use: ____________________ Time/From: _________________ To: _____________

3. Equipment requested: ____________________________________________________________

________________________________________________________________________________

4. Type of activity or use of equipment: ________________________________________________

________________________________________________________________________________

5. Individual requesting the equipment use: _____________________________________________

________________________________________________________________________________

6. Address of individual requesting equipment: __________________________________________

_______________________________________________________________________________

7. Phone number of individual requesting equipment: _____________________________________

 

I HAVE READ THE TREVOR–WILMOT POLICY REGARDING “EMPLOYEE USE OF SCHOOL EQUIPMENT,” POLICY 836 AND AGREE TO ABIDE BY ITS REGULATIONS.

Signature: ______________________________________________ Date: ___________________

_____ approved _____ not approved

___________________________________
Signature of Head Custodian or Principal

____________________________________     ____________________________________
Condition of equipment at time of loan                Condition of equipment upon return

Make 2 copies. Give original to the requestor. Give copies to the principal or head custodian and to the District Administrator.