Trevor-Wilmot Consolidated Grade School District
Employee 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 522.9 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.