EQUIPMENT CHECKOUT FORM

Name *

First Name

Last Name

Phone

(###)

###

####

What equipment will you be borrowing? *

Chromebook

PC Laptop

Kindle Tablet

iPad

Projector

Camera

Return Date (only required for checkouts of multiple days)

MM

DD

YYYY

By checking this box below you agree to following. *

I hereby certify that my name and dates are correct. I also agree to return the equipment back to Hettinger Public SchooI by the date I provided in this form. I understand that by signing out the equipment, I assume responsibility for its condition, and will accept concequences that in the event that the equipment is lost or damaged.

Yes I agree with the terms above.