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This permit authorizes use of the school equipment as listed. The person to whom this permit is issued (hereafter "Permittee") agrees to accept responsibility for care of the equipment and compliance with school board policy KGA as well as IIBG if Permittee is a student or employee of the district.

As a condition of use, Permittee agrees to pay the district fair market value for any equipment that has been lost, stolen, or has suffered irreparable damage while in Permittee's possession. If school equipment is returned damaged beyond normal wear and tear of acceptable use, Permittee agrees to reimburse the district for the cost to repair such equipment. No district reimbursement shall be assessed to Permittee for normal wear and tear of the equipment commensurate with acceptable use under policy KGA and policy IIBG if Permittee is a district student or employee.

Permittee Name:_________________________________________________________________

Address:_______________________________________________Telephone No. ____________

Group or Organization Represented, if any: ___________________________________________

Equipment Needed:_________________________________________________________________

________________________________________________________________________

_______________________________________

Date(s) of Use:_____________________________________________________________

Start Time: ____________________________

End Time: _____________________________

Insurance and Other Special District Requirements for Use:______________________________________________________________________________________________

Deposit Date and Amount Paid, if any:_______________________________________________

Principal’s Approval:________________________________________________Date: ________

Superintendent’s Approval:___________________________________________Date: ________

This form must be signed by the permittee and presented to the person responsible for the equipment on the date(s) shown. Please read all the provisions and guidelines related to this agreement. I have read the School Personal Property and Equipment Use Permit above and relevant policies thereto, and I agree that I will be responsible to see that there is full compliance with them.

1st copy: Permittee's copy

2nd copy: Building Principal

3rd copy: District office

Signature:_____________________________________________Date:_______________