Bike Room Request Form

Student ID#*

Name*

First NameLast Name

Email*

example@southernct.edu

Cell Number*

Residence Hall*

Room Number*

ex: 100

Rental Period (Check only timeframes(s) you will be living on campus):*

FallWinterSpringSummer

Bike Brand Name*

Bike Color*

Please upload a current photo of your bike*

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Agreement

· Residence Life will provide one bicycle slot on a rental basis for the period stated above.

· Residence Life is not responsible for any lost, stolen, or damaged bicycles.

· Your bike must be removed by the last day of finals of the fall and/or spring semester during which you are living on campus OR by the last day of the intersession period during which you are assigned to housing and enrolled in classes.

· Any bike left over the winter or summer without authorization will be removed by the university and donated; the cost of the removal will be billed to your student account.

· Your bicycle must be locked within the bike room with a personal lock; Residence Life will not provide bike locks.

· You are the only person permitted to access the bicycle storage room. Do not grant anyone else access to the room under any circumstances.

Prior to storage, you must sign and submit the agreement in order to be given card access to the bike storage room.

Signature

Clear