Team Number (will be assigned when kits are distributed):__________________

The team consisting of _______________________ Name 1 _______________________ Name 2 _______________________ Name 3

willingly accept as a loan a full and complete LEGO MINDSTORMS NXT Eduction kit (two boxes), a BrickPi Classroom Kit, and, at a later date, video camera and accessories for USAR Lab. This equipment is the property of the Robotics Institute at Carnegie Mellon University and must be returned in a like-new usable condition on the last day of classes of this semester, if an entire group drops the class. The group members must check all items within 48 hours of receiving them for damage. After this point, it is the group members' responsibility to care for this equipment and replace all damaged items. We have provided a parts list with their cost.

Failure to return these parts constitutes a violation of academic integrity. Groups who do not return the equipment will have their grade withheld until the equipment is returned and will be subject to the University Disciplinary Committee.

On the last day of the class in this semester, however, the members can write a check payable to Carnegie Mellon for the replacement cost of the unreturned items.

Certification of completeness:
______________________ Signature Person 1 ______________________ Signature Person 2 ______________________ Signature Person 3	_____________ Date _____________ Date _____________ Date

verify that the kit loaned to us is complete.