T4B Camera Check Out Form

Please review and if you’re younger than 18 years old a parent or guardian must also sign this agreement.

I understand that Checking out a T4B Canon Camera for my own use is a privilege and responsibility, this means not fulfilling any of the agreements below will result in my returning the equipment.

I understand that the Canon Camera is to help me with my success and I am personally responsible for the camera including maintaining and keeping it safe.

I understand that if I do not fulfill responsibilities within the before mentioned agreements, I will return the T4B equipment to Working Classroom in the same condition I received it in.

I understand that I am responsible for theCanon Camera. I will take care to keep equipment in good working condition so it may be a use to me and to T4B. I will also communicate immediately to T4B with any maintenance or other issues. I may be responsible for the maintenance or replacement of equipment if it is discovered I am at fault for not being responsible with the equipment.

I understand that I cannot and will not use any T4B equipment for illegal or unsafe activities. If it is discovered that I have done so, I will return the Canon Camera.

If Checking out a Canon Camera I understand that it is for limited time use and I will check the camera back.

I understand that if I have any questions or concerns regarding my equipment, I will contact Together For brothers at info@togetherforbrothers.org

Canon camera serial number

Youth or contractor initials

Person checking out full name

Street Address/City/State/Zip

Phone

Check out date

Date you plan to check it back in

*Parent/Guardian Name (if younger than 18 years old)

Parent/Guardian initials (if younger than 18 years old)

Parent/Guardian contact information (if younger than 18 years old)

I accept terms & conditions

Thanks for submitting!