Receipt of Media Equipment Loan
Abraham Baldwin Agricultural College

This form should be filled out COMPLETELY and in INK. Please print legibly!

Terms:
You are BORROWING equipment that is OWNED by ABAC to be used while you are a student/faculty member at ABAC.  You should treat this equipment accordingly.  By affixing your signature to this document, you agree to pay for the repair/replacement of items that become lost or damaged while in your custody, if not covered by warranty and not due to normal wear and tear.  If borrowed equipment is not returned by the specified return date, a “hold” will be placed on your records at the Registrar’s Office and a fine may be imposed.

Loan period:
Equipment is available for a maximum of 72 hours.  If not returned by the due date and time, fines will be incurred.  Fines are charged on individual items and are non-refundable.

Fines:
Late returns of media equipment are subject to fines.  The fine amount is $5.00 per day per barcoded item (e.g. camera and tripod = $5 each, $10 total per day) up to a limit of $350.

ABAC may restrict camera, computer and/or network access for those users found abusing the services provided.  It is considered unethical to:
            1) Produce or transmit copyrighted audio or video works without consent of the owner
            2) Produce audio or video clips of a personal nature which may infringe on the privacy of another individual
            3) Produce audio or video works of a vulgar, indecent or obscene nature

I, the undersigned, have read and agree to the above terms.

Student signature _________________________________________ Date _______________

Check-Out Information

Name ___________________________________________  Date ________________________

Email address ____________________________________  Phone ________________________

Address _______________________________________________________________________

If for a course, please provide course name and instructor: ________________________________

To be completed by library staff:

List contents by equipment ID #

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Note any outstanding damage before check-out

_____________________________________________________________________________________

Due date and time ____________________________________________________________

Upon check-in

Check to make sure that everything has been returned (especially check for the tripod shoe).  Note any new damage or any complaints concerning working order the borrower might have.

_______________________________________________________________________________________________________________________________________________________________________________________________________________  Date/time __________________________________________

08/2007