Belle Plaine Parks and Recreattion

Equipment loan request

Today’s Date_____________

Name___________________________________

Adress__________________________________________

Phone____________________

Date Equipment is needed_____________

Return date of equipment____________________

What purpose is equipment to be used_____________________________

List equipment needed__________________________________________

___________________________________

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I,____________________, will be responsible for the check-out and immediate return of the equipment listed above.  I agree to pay for any lost or damaged equipment which may result during my loan period.

Signature_____________________

Approved by___________________