Fillable Equipment Checkout (De Anza College)

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Equipment Checkout (De Anza College)

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Office of College Life Equipment Checkout Form
www.deanza.edu/collegelife
PLEASE HAVE CLUB OR DASB OFFICER WHO WILL PICK UP THE EQUIPMENT COMPLETE THIS FORM.
Submit form at least ten days prior to event to the Office of College Life Front Desk.
Return all equipment as originally received. Also, let us know if there is a problem with the equipment.
Equipment must be returned during normal business hours, Monday – Friday 9:00 AM – 4:00 PM.
Name of Organization:
Pickup Date: Pickup Time: Return Date: Return Time:
Name Cell Phone #
Home Phone # Email Address
Confirmation of Equipment Checkout
Approved by (Office of College Life Staff Signature) Date
*Sign below when you pick up equipment (NOT BEFORE)
I have received the following equipment from the Office of College Life. I understand that I am responsible for any
loss, theft or damage occurring while I am in possession of this equipment. I understand I will be responsible for the cost of
replacement (Purchase cost is as listed) and or cost of repairs if needed. Failure to return equipment or reimburse the
DASB/ICC/College Life for any needed repairs or replacement, by the agreed upon date and time, may result in a hold being
placed on my De Anza College record and/or referred to the appropriate De Anza College Manager. I have read and agree
with the above statement. All clubs must adhere to the ICC Equipment Guidelines in the ICC Code. Equipment must be
returned during normal business hours, 9:00 am – 5:00 pm Monday – Thursday and 9:00 am – 4:30 pm Friday.
Signature Date
For Office Use Only
Date and Time Returned Received By (Office of College Life Staff Signature)
ICC Equipment
Quantity
Equipment
Estimated
Value
A-Frame, Large, 24” x 36”
(8 available, 4 maximum)
$80
Button Maker and
up to 50 Blank Buttons
$150
Drink Tubs
$50
1
DVD Player, Portable (10” screen)
$350
Extension Cord(s)
$10
Power Strip(s)
$15
Only 1 at
a time
Game *
Title:
$10 - $15
1
LCD Projector (3 available)
$800
1
Markers, Dry Erase
$7
1
Markers, Regular
$7
1
PA System
$1,000
1
PA System, Mini
$300
Table, Portable Folding (3 available)
$40
Tent, Canopy (7 available)
$550
1
Wheel Of Fortune
$300
Other: List item(s)
Office of College Life Equipment
Quantity
Equipment
Estimated
Value
Balloons
(up to 20, only 5 on Club Day)
N/A
1
Banner, Velcro, Black
$100
1
Banner, Velcro, Yellow
$100
1
Banner, Velcro Letters, Red
$100
1
Banner, Velcro Letters, White and
Yellow
$100
Only 1
at a
time
Cart
(2 available)
$200
1
Computer Speakers
$25
1
Hand Truck
$50
Microphone for SCC (2 available)
$250
Other: List item(s)
* See Reverse or College Life for List of Games Saved As “Equipment Checkout Form.docx”, Revised August 29, 2019
GAMES
Saved As "Game Inventory.xls" Revised October 24, 2013
GAMES
G01 JENGA
G02 MONOPOLY
G03 TABOO
G04 TOURNAMENT DOMINOES
G05 TWISTER AND 7 MATS
G06 - G08 APPLES TO APPLES (3 sets)
G09 PICTIONARY
G10 - G14 UNO CARD GAME (5 sets)
G15 MASTER LABYRINTH
G16 TERRACE
G17 WHAT'S YOURS LIKE
G18 MONOPOLY
G19 - G20 CONNECT 4
G21 GUESSTURES
G22 TABOO
CHECKOUT INSTRUCTIONS: Please fill out the Office of College Life Equipment
Checkout Form on the reverse side of this list. In the ICC Equipment section please
check Game and list the item(s) you want to check out.
These items are intended for ON-CAMPUS USE ONLY.
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Equipment Checkout (De Anza College)

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Completed 22 July 2020

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