Since a couple of people requested it, I'm sending along a copy of what we use here.  The form itself is in AppleWorks, so I'm sending a text version of it that might turn out a little funky.  The text of the cover letter is below:

Off-Campus Use of Equipment


     AV and technology equipment may be taken off campus for school-related activities, including field trips, off-site professional development, and for the purpose of learning how to use it.  Strictly personal uses are not allowed.  If you have questions about whether your situation applies, please contact your building administrator.

     Since we have smaller supply than potential demand for much of this equipment, you should identify a clear and reasonable amount of time for it to be in your possession, and return it promptly so that it is available for others to use.

     We encourage you to use AV and technology tools in your record keeping and curriculum.  If you need assistance in operating the equipment, do not hesitate to ask your tech support or AV personnel.

     We especially encourage you to take a classroom computer home for the summer to practice and hone your skills.
     Use the form on the reverse side to sign the equipment out.  This form applies only to off -campus use.

     The borrower bears full responsibility for the appropriate use of this equipment and for its return in undamaged condition.

Tommy Walz
Technology Coordinator

Tommy J. Walz
Technology Coordinator
Barre Supervisory Union
120 Ayers St.
Barre VT 05641

Tel 802-476-5011