Adopted:          08/18/2008

                                                                                                  443.91 Exhibit

School District of Prairie Farm

Apparel/Equipment Request

Name: ___________________________

Address: ___________________________

Name of Camp or Non-School Competition:

Date(s) of Use: __________________ Return Date: __________________

Describe how the apparel/equipment will be used and the level of supervision that will be provided:

I understand that any apparel or equipment used will be returned in the same condition as loaned, normal wear and tear excepted. I further understand and agree that the district will charge for damage to the apparel or equipment.*

__________________________________________ __________________

 Parent Signature                                                                                  Date

I attest that I have been instructed on the proper use of the equipment requested in this application.

 ___________________________________________ __________________

Student Signature                                                                                  Date

* Estimated replacement value of this equipment: _____________