TechOwl Library Card Registration

Get a TechOWL Library Card Number

You will need this number to reserve items from the library.
We want everyone to be able to connect with us - and - we need to keep your information secure. If this form is hard for you to use, please contact us and we will take your information in a different way.
Your Information

Please enter your information. If you are borrowing for another person, you will enter their information next.
Full Name *

First Name Last Name
Street Address *
(for the person completing this form)
City *
(for the person completing this form)
State *
(for the person completing this form)
Zip Code *
(for the person completing this form)

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

County in Pennsylvania *
E-mail *
Phone Number *

Area Code Phone Number
Is this the address for delivery and pickup of the items requested?

Yes No
Is this your first time borrowing from us?

Yes No
I am a... *

Person needing tools or technology Parent / Spouse / Family Member Supports Coordinator Service Provider Employer Educator / Student Health / Allied health / Rehabilitation provider
Person who will be using the equipment

Please complete this next section for the person who will be using the equipment.
Name of person using the equipment *

First Name Last Name
Age of person using the equipment *
Name of parent / guardian of minor child *
Street Address *
(of person using the equipment)
City *
(of person using the equipment)
State *
(of person using the equipment)
Zip Code *
(of person using the equipment)
County in PA *
(of person using the equipment)

Phone Number *

Area Code Phone Number
Email
example@example.com
Please select all of the systems that the person using the equipment is involved with. *

Early Intervention Public School Private School Office of Mental Health Office of Developmental Programs Office of Vocational Rehabilitation Blindness and Visual Services Area Agency on Aging / Senior Center None
Race / Ethnicity of person using the equipment *

Caucasian / White African American Asian Latino I prefer not to tell you.
Reason for borrowing this equipment *

To see if this equipment will be helpful and worthwhile to the person trying it. To use for a specific accommodation (to use in work setting or during a public event.) To use as loaner during device repair or while waiting for funding. To learn about the equipment as part of my professional development.
This equipment will be used MOSTLY at *

school home or community work
Delivery and Pick Up Address

If different from borrower's address
Name

First Name Last Name
Organization or Agency
Department
Street Address
(for delivery & pickup)
City
(for delivery & pickup)
State
(for delivery & pickup)
Zip Code
(for delivery & pickup)

Support Person

Some equipment is complicated and needs support from another person to assist the person using the equipment. If the item(s) you want to borrow require support, that information is in the catalog. For items requiring support, please tell us about the support person.
Do the item(s) you are requesting need support? *

Yes No
Support Person's Name

First Name Last Name
Agency or Organization
Title
Email
example@example.com
Phone Number

Area Code Phone Number
Borrower's Responsibility & Liability

This is what you promise to do.
I understand and agree that I am responsible for the proper handling and use of the device(s).

I am responsible for returning all components to Pennsylvania’s Assistive Technology Lending Library in a timely manner and in accordance with delivery instructions. If I find that any components listed on the inventory sheet are missing when I open the shipping case, I must call the Assistive Technology Resource Center for my region immediately so I will not be held financially liable for the missing components.

In the case of loss of a device or components, I will be held financially liable. In the event of loss, I will contact the Assistive Technology Resource Center in my region immediately.

The total replacement value of the item(s) I want to borrow is listed in the catalog plus the cost of the shipping case, if applicable.

In the case of theft, I will not be held responsible, as long as I immediately report the incident to the police and provide a copy of the police report to the Institute on Disabilities at Temple University.

If an equipment breakage or malfunction occurs, I must immediately notify the Assistive Technology Resource Center for my region. I will not be held responsible for equipment breakage or malfunction that occurs during normal use as long as I report it promptly.

If there is a change in the pickup address, I will notify the Assistive Technology Resource Center prior to the scheduled pick up date.

I understand it is illegal to copy or distribute any software loaned through Pennsylvania’s Assistive Technology Lending Library. Upon completion of the loan period, if I have loaded borrowed software on my computer, I will remove it.

Failure to comply with these responsibilities will result in loss of future access to Pennsylvania’s Assistive Technology Lending Library, in addition to applicable financial liability.
I agree to the BORROWER'S RESPONSIBILITY AND LIABILITY. *

Yes No
Release of Liability

This means that you are using the borrowed items at your own risk.
I agree to indemnify and hold harmless the Institute on Disabilities, Temple University, Hiram G. Andrews Center, the Office of Vocational Rehabilitation, the Department of Labor and Industry, the Commonwealth of Pennsylvania, and any and all employees, agents or representatives of same, from damages to property or injuries (including death) to myself, and/or any other person, and any other losses, damages, expenses, claims, demands, suits, and actions by any party against the Institute on Disabilities, Temple University, Hiram G. Andrews Center, the Office of Vocational Rehabilitation, the Department of Labor and Industry, the Commonwealth of Pennsylvania, and any and all employees, agents or representatives of same, in connection with loan(s) from Pennsylvania’s Assistive Technology Lending Library.

I understand that it is my responsibility to remove all personal information such as photos, videos, recordings, maps, locations, names, etc. prior to the end of the loan period. I also understand that should I fail to do so, I release the Institute on Disabilities, Temple University, Hiram G. Andrews Center, the Office of Vocational Rehabilitation, the Department of Labor and Industry, the Commonwealth of Pennsylvania, and any and all employees, agents or representatives of same, from all liabilities that such exposure of personal information could pose, including but not limited to, identity theft or impersonation.
I agree to the RELEASE OF LIABILITY *

Yes No
I live in Pennsylvania and am over 18 years old. *

Yes No
How did you hear about us? *

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