Alarama Equipment Check-Out Form printable pdf download

EQUIPMENT CHECK-OUT FORM

This policy applies to all firearms and equipment which is property of the

ACES/Alabama 4-H & Youth Development Program.

Keep this form on file for 12 months after equipment is checked in.

AL 4-H S.A.F.E.: Form 006

CONDITIONS (By initialing each item, I acknowledge that I have read and understand each condition):

_____1. Only currently enrolled, Direct Alabama 4-H Volunteer Leaders who are certified as 4-H Shooting Sports Instructors may check out firearms

and equipment. Further, leaders must be certified in the specific discipline relating to the equipment. Teen leaders may not check out

equipment.

_____2. The individual listed below assumes total responsibility for the equipment until it is returned. If equipment is lost or stolen, then the State

4-H S.A.F.E. Coordinator (Contact Information Below) must be contacted immediately. Leaders may be required to purchase replacement

equipment if found to be negligent.

_____3. Firearms and equipment are only to be used for official 4-H activities and events.

_____4. When not in use, firearms must be unloaded, cleaned, and locked with firearm safety devices (FSD) properly installed. Firearms must be

inaccessible at all times to children and unauthorized adults.

_____5. Equipment may not be altered without written consent of the 4-H S.A.F.E. Program.

_____6. Equipment may be transported only by the individual listed below. Firearms must be transported with FSDs properly installed, cased, and

out of sight.

_____7. Firearms must be returned thoroughly clean and in the same condition that they were when checked out. Any damage will be the

responsibility of the individual who checked out the equipment. Normal wear is allowable. Upon return, respective maintenance logs

should be completed.

_____8. All 4-H S.A.F.E. activities should be conducted strictly under the safety guidelines listed in the current 4-H Shooting Sports Guide for each

discipline. These standards apply to all youth and adult participants.

_____9. A copy of my current Driver’s License is attached to this form (required only for Volunteers)

Name: ____________________________________________________ Discipline: _____________________________

County: ______________________ Check-out Date: _______________ I will return the equipment on: ____________

Complete Mailing Address: ___________________________________________________________________________

Home Phone: ________________________Work: ______________________ Mobile: __________________________

Equipment Type (Air Rifle, BB, Shotgun,

Caliber/Gauge

Manufacturer

Serial Number

Inventory Number (if applicable)

Muzzleloader, Air Pistol, Rifle, Bow, Arrows)

(Attach additional page if needed)

Ammunition or Arrows Checked Out

Caliber/Gauge

Quantity/Amount

Purpose (practice, competition, field day, etc.)

Shotgun

Airgun

Rifle

Black Powder or equivalent

Lead balls

Arrows (list quantity only)

As the party responsible for this equipment, I have read and agree to strictly adhere to the above-listed conditions.

____________________________________________ _______________________

Signature

Date

If Volunteer Check-Out, Signature of Responsible ACES Staff: ________________________________________________

Send this to: Alabama 4-H State Shooting Sports Coordinator

Shannon T. Andress, M.Ed. ~ Regional 4-H Extension Agent III ~ 334-270-4133 and 334-750-4591 ~ Email:

andresh@aces.edu

Please note: If you have not been contacted by the State 4-H S.A.F.E. Coordinator within 10 working days you will need to check on the status of your

request.

Alarama Equipment Check-Out Form

Related Articles

Related forms

Related Categories