SIRA Outdoor Recreation and
Equipment Check Out Reservation Form
Important Notes to Potential Equipment Users:
This is a request form only. You will
receive a confirmation email within one business day. This
email will indicate whether
or not your reservation can be processed/confirmed.
#2 - Please make all
reservation requests by noon on the day prior to the
desired pick up (see check
out days/times below) in order to provide sufficient time
to process your reservation and prepare the equipment.
#3 - Failure to complete this reservation
form correctly/completely and/or to have adequate funds
available to cover the required deposit will inhibit SIRA's
ability to process/confirm your request in a timely manner.
#4 - If you have questions, review our Policies
and Procedures and/or you may
contact at us firstname.lastname@example.org or
Name and contact information:
(include first and last)
(use SU e-mail)
A Refundable Deposit of $50 is required
all of equipment users. Please indicate which
method you will utilize to pay this deposit: Pirate Card
or check. These are the only two forms of deposit that
SIRA will accept. WE DO NOT ACCEPT
CASH DEPOSITS. If
you have cash available, you may go to the Pirate Card
machine in the Campus Center and add those $'s to your
Charge my Pirate Card $50 for the deposit.
I'll enter my card number below and I understand that SIRA
will hold my $50 while I have the equipment and while processing
the gear upon return. Note: A balance less than $50 on a
Pirate Card will cancel your request if you choose that
method of deposit.
Pirate Card Number
(Please use the number on the back of your
I'll bring a $50 check payable to "Southwestern University"
with me when I pick up the equipment.
Equipment to be Checked Out
Please list the equipment that you wish to reserve for
checkout. Please be aware that each individual may check
out no more than six (6) pieces of equipment at one time
[note: each individual may check out
a maximum of two (2) tents]. Not sure what equipment SIRA checks out? Check
our list of available equipment.
Please list equipment desired and number of each item.
Remember, the total number of items must be 6 or less.
Acknowledgement of Financial Responsibility for
I assume full responsibility for the
equipment borrowed and all accessories to said equipment;
and upon request agree to pay damages incurred to said
equipment (or replacement cost if equipment is lost or
beyond repair) in excess of normal use and depreciation as
assessed by the SIRA
I understand that I am responsible for retuning this equipment
and accessories no later than 3:30 PM on the Monday
following pickup (unless other arrangements are made at
time of pickup); and
this equipment is to be properly cleaned,
dried, and packed prior to its return. I further understand
that a late fee may be charged for equipment returned after
the agreed upon date.
I have read and understood the above agreement
(Check box to indicate agreement).
Select a Month/Day/Time to Pick up Equipment
SIRA has student staff members to issue equipment
and answer your questions about the equipment. These student
staff members are available at the following days/times
each week. Please plan to pick up your gear at one of these
times since any other pickup day/time
will require special scheduling of staff to meet your request.
Staff Days/Times for Fall 2013
- Thursday 10:30am or 12:15-3:30pm
- Friday 10:15am - 4:30pm
Requested pickup Month/Day/Time
Comments/questions about equipment checkout
(not a required
Upon submiting this form you will receive an
e-mail from SIRA within one working day acknowledging your
request and confirming your equipment reservation or you
will be provided a reason as to why the reservation
cannot be filled
(e.g. equipment not available or insufficient
funds on Pirate Card).