CLUB:

CLUB: ____________________

CLUB SESSION: M / T / W / TH / F / SA / SU

Appointment of Authorized Person Form

Authorization Agreement

I hereby authorize that the people listed below to initiate a club equipment storage at the Sports
Complex store during Club Session and Sports Complex will not be responsible for any loss of the
equipment. This agreement will remain in effect until a written notice of cancellation, or a new
Authorized Person Form issued.

Authorized Person details

1. Equipment Manager
a. Name : __________________________________
b. ID Number : __________________________________
c. Uni. Email : __________________________________ PHOTO
d. Telephone : __________________________________

2. 2nd Person
a. Name : __________________________________
b. ID Number : __________________________________
c. Uni. Email : __________________________________ PHOTO
d. Telephone : __________________________________

Authorized by

Club’s President Sports Complex Sign & Stamp:

____________________
Name:
ID Number:
Uni. Email:
Date: / /
 Equipment’s Details

No. Item Quantity

1

10

11

12

13

Authorized by

Club’s President Sports Complex Sign & Stamp:

____________________
Name:
ID Number:
Uni. Email:
Date: / /