Equipment Request Form - Girl Scouts

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EQUIPMENT REQUEST FORM
STAFF USE ONLY
Date rsv’d:_________Staff initals:__________
RESOURCE CENTER
Fee Req: $ Dep. Req: $_________
(210) 349-2404 or 1-800-580-7247 (ext. 382)
Maximum deposit required: $100.00
fax (210) 349-2666
Library Card Scan: [ ] clear [ ] restricted
Members must have a Resource Center Library card to check out equipment, and the account
Dep Amt: $________ Check #:_________
MUST be in good-standing before equipment can be checked out.
Check/Card Name:___________________________
Due to extreme demand for our equipment we ask that you schedule your pick-up date no more than
Credit Card #:_______________________________
TWO DAYS PRIOR to date of use and schedule the return date within TWO DAYS AFTER the date
CC type:________ Exp. Date:_________
of use. (Members coming from longer distances will work out pick-up and return dates with resource
[ ] Deposit Check Returned
center staff.) Equipment borrowed from the Resource Center MUST BE RETURNED ON TIME!
Equipment returned late will be charged $2.00 per day. A $5 cleaning fee will be charged for
Date:________ To:____________________________
equipment returned unclean. You will be charged for lost or damaged items. Fees incurred
Mailed to Address on: [ ] check [ ] form
will be deducted from the deposit. NO EXCEPTIONS!
Transferred to next kit—date:________
Kit Checked—date:________ initials:________
Kit Restocked—date:_______ initials:_______
Kit Cleaned—date:________ initials:________
Person responsible for item:__________________________________________________________________________ Card #: 2—0312—0000__ __ __ __ - __
Phone: Day # (____)_________________ Eve # (____)_________________ Other # (____)__________________
Address: _________________________________________________________ City: ____________________________________ Zip: ___________________
Group #:__________ # of girls________ Service Unit___________________________ e-mail______________________________________________________
I agree to be responsible for the items I have requested for check out. My deposit (if any) will be returned to me upon return of all borrowed equipment ON TIME
and in good condition. I understand that I am responsible for cleaning borrowed equipment, replacement of lost or damaged items and am subject to late
fees of $2.00 per day. All fees incurred will be deducted from my deposit.
Signature_____________________________________________________________ Date ______________________________
Check the program materials you wish to reserve. (1/20) denotes use fee/deposit required.
RESOURCE KITS— kits are limited to 3 month advance reservation
MULTI—LEVEL KITS (10/25)
Journey Quick Start Packets (5/10)
DAISY ACTIVITY KITS (10/25)
FINANCIAL LITERACY BADGE KITS (10/25)
_____ Girl Scouting & Me
_____ Welcome to the Flower Garden
DAISY
_____ Artist Legacy Badge—Brownie to Amb
_____Anti-Bully—Daisy to Junior
_____Count It Up—Leaf kit _____Talk It Up - Leaf Kit
_____ Between Earth & Sky
(Promise Center, Sister to
_____ Anti-Bully—Cadette to Ambassador
Every GS)
_____Making Choices—Leaf Kit
_____Athlete Legacy Badge—Brownie to Amb
_____ 5 Flowers, 4 Stories, 3 Cheers…
_____Citizen Legacy Badge—Brownie to Amb
_____Money Counts—Leaf Kit
______ Daisy GS Discover
_____ Brownie Quest
_____Cook Legacy Badge—Brownie to Amb
_____GS Law Board Game
(Honest & Fair, Considerate &
_____ WOW! Wonders of Water
_____GS Ways Legacy Badge—Brownie to Amb
BROWNIE
Caring, Courageous & Strong)
_____ Healthy Self Esteem—Daisy to Junior
_____ A World of Girls
_____Give Back
______Money Manager
_____ Daisy GS Connect
_____Healthy Self Esteem—Cadette to Amb
_____Meet My Customers _____Philanthropist
_____ I Am America!
_____ Agent of Change
_____ Get Moving
(Respect Self & Others, Re-
_____ Leadership—Daisy to Junior
spect Authority, Resp Say &
_____ Amaze!
_____ Breathe
_____ Media
_____ Leadership—Cadette to Amb
JUNIOR
Do)
_____Mental Health Awareness (5/10)
_____ GIRLtopia
_____ Sow What?
_____Naturalist Legacy Badge—Brownie to Amb
_____Business Owner
_____Cookie CEO
_____ Daisy GS Take Action
_____ PUG Kit—Daisy to Brownie (10/20)
_____ Mission: Sisterhood!
_____Customer Insights
_____Savvy Shopper
(Friendly & Helpful, Resources
_____ PUG Kit—Junior to Amb (10/20)
_____ Your Voice, Your World
_____ Justice
Wisely, Make World Better)
CADETTE
_____ bliss live it!
HEALTHY HABITS KITS (10/25)
_____Budgeting
_____Business Plan
JOURNEY BADGE SKILL SET KITS
_____Comparison Shopping _____Financing My Dreams
(10/25)
___Daisy—Between Earth & Sky
_____Marketing
_____Think Big
___Brownie—Wonders of Water
___Brownie—Quest
___Junior—Get Moving
SENIOR
___Brownie—Wonders of Water
_____Buying Power _____Customer Loyalty
___Brownie—World of Girls
_____Financing My Dreams _____My Portfolio
___JR—Agent of Change
AMBASSADOR
___JR—Get Moving
_____Good Credit _____Research and Development
___JR—Amuse
_____Promise and Law _____On My Own
CEREMONY & PROGRAM EQUIPMENT (list # of items needed)
BRIDGES (5/20)
MISC CEREMONY KITS (10/20)
CEREMONY BOARDS (5/10)
MISC CEREMONY EQUIP
_____ Rope Bridge
_____ Basket Full Daisies
_____ My Pledge Candlelight
_____ Candle
_____ Birthday/Cupcake
_____ Mirror (3/10)
_____ Small Hump Bridge
_____ Flowers of GS Law
_____ Daisy Flower Garden
_____ Balloon
_____ Greenery Vine (1/5)
_____ Large Hump Bridge
_____ GS Colors Candlelight
_____ Brownie Ending
_____ World Association Pin (large)
_____ Traditional Candlelight
_____ World Association Pin (small)
***For Resources Available at the West Side Girl Scout Leadership Center Contact 210-319-5775 ext. #423***

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