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 NameLast 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

CityState / Province

Postal / Zip CodeCountry
County in Pennsylvania*
E-mail*
Phone Number*

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

YesNo
Is this your first time borrowing from us?

YesNo
I am a...*

Person needing tools or technologyParent / Spouse / Family MemberSupports CoordinatorService ProviderEmployerEducator / StudentHealth / Allied health / Rehabilitation providerOther
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 NameLast 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)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

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

Early InterventionPublic SchoolPrivate SchoolOffice of Mental HealthOffice of Developmental ProgramsOffice of Vocational RehabilitationBlindness and Visual ServicesArea Agency on Aging / Senior CenterNoneOther
Race / Ethnicity of person using the equipment*

Caucasian / WhiteAfrican AmericanAsianLatinoI prefer not to tell you.Other
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.Other
This equipment will be used MOSTLY at*

schoolhome or communitywork
Delivery and Pick Up Address

If different from borrower's address
Name

First NameLast Name
Organization or Agency
Department
Street Address
(for delivery & pickup)
City
(for delivery & pickup)
State
(for delivery & pickup)
Zip Code
(for delivery & pickup)
Delivery and Pick Up Address

Street Address

Room or Apt.

CityState / Province

Postal / Zip Code
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?*

YesNo
Support Person's Name

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

Area CodePhone 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.*

YesNo
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*

YesNo
I live in Pennsylvania and am over 18 years old.*

YesNo
How did you hear about us?*

Web SearchAnother PersonA PresentationOther
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