Shippensburg University Office of Housing and Residence Life Initiatives Program Order Form

First & Last Name                                        Date of event:    [None] Select a Date Delete the Date

Name of organization                          Number of People       

Set up/pick up time   [None] Select a Date Delete the Date        Start Time of Event:    [None] Select a Date Delete the Date

What areas do you feel your group needs growth in?  (You may check more than one area and/or sub area):  







 Team Building


Do you need a facilitator?     
If yes, please provide additional dates and  times of availability. 

 Does your group need any special accommodations?      
If yes, please explain.   

 Contact Information (This is the preliminary contact person who will be responsible for the pick, return, and care of Shippensburg University Initiatives materials)
 Name          Phone    
 Email           Organization Advisor   

Terms of Agreement: Shippensburg University Office of Housing and Residence Life Initiatives Program is designed to help organization grow in areas of development and strengthen bonds between individuals. It is our hope that these tools and games will provide your group with the support and growth requested. Please not the following terms and conditions in using the program:

1.)    Safety is the number one priority of the Initiatives Program. Please note that the Initiatives Program is not responsible for any injuries sustained during an initiatives game, (im)proper use of materials, and/or any other circumstance where a participant may be injured.

2.)    It is the responsibility of the customer to ensure that all equipment and/or materials is returned to the Shippensburg University Office of Housing and Residence Life Initiatives Program in the state which it was borrowed.

3.)     In the event that equipment and/or materials is not returned or damaged beyond repair, responsibility will fall on the individual requesting the material or the organization for which they are representing to replace said items.

4.)    The Initiatives Program has the right to deny certain materials and/or activities to customers in the event that they feel the customer’s safety is at risk.

5.)    The Initiatives Programs may provide a facilitator upon request or train individuals within the organization to facilitate programs. Please understand that we have a limited number of facilitators and are requesting a two week notice for need of facilitators.

6.)    Materials, facilitators, and locations are subject to change in the event that one or more of these cannot be provided.

7.)    In the event that you need to cancel your appointment, it is the customer’s responsibility to notify the Initiatives Program as soon as possible.

     By checking this box I hereby understand and accept all terms and agreements 

Electronic Signature           Date:   [None] Select a Date Delete the Date