Equipment Check Out Form - Prescott Media Center
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1EQUIPMENT CHECK OUT FORM
Scheduled Pick Up: __________/_____
Scheduled Return: __________/_____
Date
Time
Date
Time
Member/User __________________________
Phone ______________________________
EQUIPMENT IS DUE BACK BY 12:00 PM ON SCHEDULED RETURN DATE.
IF YOU NEED TO RETURN IT LATER, YOU WILL NEED TO MAKE ARRANGEMENTS WITH A STAFF
MEMBER. IF NO ARRANGEMENTS ARE MADE, YOU MAY BE CHARGED A $10 LATE FEE (Per Day).
ITEM
QUANTITY
Camera #
Tripod #
Wireless Mic #
Wired Mic #
Mic Cable #
Cables:
Other:
I agree to accept full responsibility for returning all equipment released to me in good condition, *except
as noted below and initialed by staff. Failure to sign or have staff initial below implies I accept
responsibility for any damage found later. I further understand that it may take as many as two business
days for staff to check equipment when returned, and that I will be held responsible for any damage
found whether the equipment is checked in my presence or not.
Equipment Condition
Equipment Inspection
At PICK UP
At RETURN
Member has inspected equipment
Staff has completed initial inspection and
found equipment complete upon return.
Member DECLINED inspection
Detailed inspection to be performed.
_________________________________________
____________________________________
Member/User Signature
Staff Initials
Record of field camera hours: (at checkout) ____________
(at return) ___________
PRESCOTT MEDIA CENTER
P.O. Box 885 Prescott, AZ 86302
928.445.0909
Equipment Check Out Form, Version 4-12-17
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Parent category: Life