WHITEWATER COMMUNITY TELEVISION EQUIPMENT CHECK-OUT Name ______________________________ Certif. No. ___________ Address _________________________________________________ ________________________________________________________ Home Phone __________________Work Phone ________________ Organization _____________________________________________ Org. Address _____________________________________________ Org. Phone No. ___________________________________________
FOR WCTV USE ONLY EQUIPMENT RESERVED FOR: F R O M T O DATE: _______________ TIME: ________________
DATE: ________________ TIME : ________________
APPROVED DENIED BY: __________ DATE: _________
Requested for: REASON: ____________________ From: Date __/__/__ Time __:__ (AM/PM) ______________________________ To: Date __/__/__ Time __:__ (AM/PM) ______________________________ Production Location (s) ______________________________________ __________________________________________________________________________________ Location Phone _____________________________________________________________________
In consideration for the use of television production equipment provided by WCTV for access programming, I hereby agree to the following: 1. I hereby acknowledge I have received, read, and understand WCTV Rules and Procedures. 2. I agree to exercise reasonable care in use of the equipment and at all times keep the equipment in a safe place. I agree to pay the costs of any repair or replacement of equipment or materials that are damaged or lost as a result of, but not limited to, mistreatment, accident, neglect, misuse, loss, theft or vandalism while the equipment is in my possession or control. I agree to return the equipment at the time stated. I agree to pay reasonable attorneys fees and collection costs incurred by WCTV in collecting or attempting to collect any sums due under this agreement. I agree that the intended use of the equipment is to produce programming for the Whitewater Community Television access channels, and that the equipment will not be used in any way for personal profit or remuneration. I further agree that the equipment will not be used in violation of any City, State and Federal Laws. False or misleading statements in this application are grounds for forfeiture of the right to use WCTVs equipment and facilities.
Use of the equipment is to produce the following program: ___________________________________ C HO EU CT K C HI EN C K I hereby accept this equipment in good working condition. All exceptions are listed below: ____________________________________________________________________________ ____________________________________________________________________________ User Signature ____________________________ Date: _____________ Time: ____________ WCTV Staff Signature ______________________Date: _____________ Time: ____________ Equipment has been returned in good working condition. All exceptions are listed below: ____________________________________________________________________________ ____________________________________________________________________________ User Signature ____________________________ Date: _____________ Time: ____________ WCTV Staff Signature ______________________Date: _____________ Time: ____________
WCTV EQUIPMENT CHECK-OUT LIST
OUT CAMERA: With lens, viewfinder, power supply & case Panasonic AG-450 Panasonic AG-455U Panasonic AG-456 (1) Panasonic AG-456 (2) Panasonic AG-456 (3 Panasonic AG460 Panasonic AG-DP800HP (1) Panasonic AG-DP800HP (2) GENEVA CAMCORDER BAG (1) Jerrold T-Channel Modulator GENEVA CAMCORDER BAG (2) GENEVA CAMCORDER BAG (3) Camcorder Bags 1, 2 & 3 equipped with: 2- Shure SM63-LB microphones 4- Astatic 901 table microphones Labtec LT-810 headphones Studiomaster Compact 4-2X mixer Audio-Technica CP8506 Phantom Pwr Radio Shack Battery Tester 5 S cable 5 video dual audio RCA to RCA cable 6-outlet power strip 25 AC extension cord (orange) 4- 8 XLR cables 2- 25 XLR cables 6 XLR female to 1/8 male phone plug 6 1/4 male phone to 1/8 male phone CAMERA TRIPOD BOGEN 3142 BOGEN 3193 (1) BOGEN 3193 (2) BOGEN 3189 Tripod Spreader (1) BOGEN 3189 Tripod Spreader (2) BILORA PRO 930-S (1) BILORA PRO 930-S (2) BILORA PRO 930-S (3) SAMIGON BSA650 (1) SAMIGON BSA650 (2) SAMIGON BSA650 (3) VELBON STRATOS 480 Tuffpak Tripod Case (1) Tuffpak Tripod Case (2) Bescor tripod bag (1) Bescor tripod bag (2) Bescor tripod bag (3) Access Producer __________________________________ Check-out Date ______________ Time _______________ Panasonic/Anton Bauer Battery (1) Panasonic/Anton Bauer Battery (2) Panasonic/Anton Bauer Battery (3) Panasonic/Anton Bauer Battery (4) Panasonic AG-7350-P S-VHS VCR Realistic in-ear headset Audio-Technica Lavalier Condenser (1) Audio-Technica Lavalier Condenser (2) Audio-Technica Lavalier Condenser (3) Audio-Technica Lavalier Condenser (4) Tam Tec Camcorder Bag (1) Tam Tec Camcorder Bag (2) Panasonic/Fujinon Lens Control Kit (1) Panasonic/Fujinon Lens Control Kit (2) Kits include: 5 viewfinder zoom controls focus controls MIXERS Realistic stereo 32-1100A Realistic four-channel 32-1105A (1) Realistic four-channel 32-1105A (2) Realistic four-channel 32-1105A (3) OTHER: IN MICROPHONES Realistic PZM 33-1090B (1) Realistic PZM 33-1090B (2) Realistic PZM 33-1090B (3) Realistic PZM 33-1090B (4) Azden wireless mic kit Telex wireless mic system (1) Telex wireless mic system (2) IMA 5 Color Receiver/Monitor OUT IN