Borrow-A-Camera Form

Borrow-A-Camera Rental Form

Fill out the form carefully and reach out to emily@insight-photography.org with questions
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Pronouns*
Participant's Email
example@example.com
Participant's Phone Number
Parent/ Guardian's Name*

First NameLast Name
Parent/ Guardian's Email*
example@example.com
Parent/ Guardian's Phone Number*
Participant's Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which email and phone number should we use to share information about class?

Youth onlyParent/ Guardian OnlyBoth
This student would like to borrow*

A DSLR CameraA Pentax K100 Analog Camera
When can you pick-up the camera? The earliest cameras will be ready for pick-up is September 30th.

MonthDayYear
Date
Please indicate the time you expect to pick-up your camera. In-Sight is generally open M (9 - 2), T (1 - 7), W (11 - 3), TH (9 - 2), and F (1-7), but special accomodations can be made.

Hour Minutes

AM/PM Option
Second Adult Contact*

First NameLast Name
Second Adult Contact Phone*
Please enter a valid phone number.
Second Adult Contact Email*
example@example.com
Our programs are made possible through grants and the generosity of our community. Please help us collect the needed data to demonstrate our community's need for financial support to our programs. Select all that apply. All information is confidential and it is optional to share. Thank you!*

The student/student's family qualifies for aid such as SNAP food assistance (3SquaresVT), Medicaid, Section 8 housing assistance.At least one legal guardians serves/has served in the armed forces.The student is in foster care or has been in foster care.The student has limited English proficiency.The student is houseless or at risk of being houseless.At least one legal guardian is currently serving time, or has served a period of time, in jail or prison.The student is at risk of not completing high school.The student is eligible for free or reduced lunch at school.The student regularly uses public transportation.The student does not have access to adequate broadband internet at home.None of the above
Household Income*

$0 - $50,000$50,000 to $100,000$100,000 to $150,000$150,000 +
Borrowing Agreement

As the parent/ guardian of the above named student, agree to let the student borrow In-Sight's camera from the above pick-up date until Friday, Dec 13th. I will do all I can to ensure In-Sight's equipment is well cared while being borrowed. I understand that in class, students are shown proper camera care and we expect them to follow those instructions while using the camera at home. In-Sight understands accidents happen and we hope that students can alert any incidents or problems with the camera as soon as possible to Emily, emily@insight-photography.org. If we feel a student was blatantly negligent with a camera we reserve the right to terminate the borrowing agreement.
Signature*

Clear
To borrow a DSLR or Pentax K1000, there is a suggested donation of $100 though it is not required. Use the camera for as long as you like between Sept 30th and Dec 13th. What can you contribute?*
I plan to pay using my*

Credit Card/ PayPal (link below)Checking Account/ Cash (drop off at In-Sight)
Make your donation now!

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USDIn-Sight asks for a deposit of 50% of the total pledged amount. The deposit pays for the preparation of the class: staff time, equipment, and supplies. In most cases we cannot refund deposits, but we can transfer funds for one class to another. An invoice will be sent in advance of the class and the remaining pledged fee is due the week of your student's class. We will not turn a student away for lack of family funds. Please contact Program Director Michael, michael@insight-photography.org, if you have questions.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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Borrow-A-Camera Rental Form

Borrowing Agreement