Facilities_Use_1330_Form_5

1330
                                                                                                                  Form 5
                                COLCHESTER PUBLIC SCHOOLS
                               AUTHORIZATION FORM for
                   USE OF SCHOOL PERSONAL PROPERTY OR EQUIPMENT
In accordance with the policy of the Colchester Board of Education, I hereby seek authorization to use the following school
property or equipment off school premises:

1.       Property or Equipment: (Describe with specificity, include model, serial numbers where available)
         ____________________________________________________________________________________________
         ____________________________________________________________________________________________

2.       Conditions of property or equipment: (Description by School Principal)
         ____________________________________________________________________________________________
         ____________________________________________________________________________________________

3.       Purpose for use of property or equipment:___________________________________________________________

4.       Date property or equipment will be removed from school premises: ______________________________________

5.       Date property or equipment will be returned:_________________________________________________________

6.       Date property or equipment will be used on school property: ____________________________________________

7.       Type/Name/Kind of school equipment needing a trained operator: _______________________________________

8.       Name of person who is a competent operator of equipment loaned (if training is required to operate equipment):
         ____________________________________________________________________________________________

9.        Name of school staff who knows of the competency of the proposed operator of the school equipment:
          ____________________________________________________________________________________________
I assume full responsibility, including any necessary insurance for returning the property or equipment listed above in its
present condition. I understand that my failure to return such equipment in the same condition in which it was lent to me shall
make me personally liable for repairing and/or replacing such equipment.

____________________________________________________________________________________________________
        Name (please print)                   Signature                              Date

____________________________________________________________________________________________________
        Address                               Town                    State          Zip Code

____________________________________________________________________________________________________
        CT drivers license #

I have reviewed this request, and it is approved:
____________________________________________________________________________________________________
          Signature of School Principal                                              Date

____________________________________________________________________________________________________
        Date Returned                                 Condition of returned property/equipment

The above property/equipment has been returned in the condition described above:

____________________________________________________________________________________________________
        Signature of School Principal                                                Date

One copy of approved form to applicant - One copy in School File