NAME:
ROOM #:
Item
# of Items at
Check-In
Condition at
Check-In
# of Items at
Check-Out
Condition at
Check-Out
Comme
KAPPA DELTA 201__—201__
ROOM CONDITION AGREEMENT
Door
Window Lock
Procedure:
Frame
During check-in eachBed
resident
should inspect the condition of each item in her living space. Check all furniture and
Mattress/Cover
items in the room carefully! Please take note of any damages and/or irregularities (tape marks, stains, nails, burn
marks, etc.). If there is a
concern, please note it on the reverse side and sign this form. This form must be
Desk
reviewed, signed, and
returned
Desk Chairto the house director as soon as possible.
Closet/Wardrobe
Responsibility:
Dresser
All residents will be financially responsible for damages and missing items that were not accounted for during
Towel
Rack
check-in. If the house
director
is unable to determine which resident is responsible for a damaged or missing item,
(Possibly in closet)
that cost will be divided equally among residents in the living space. Upon check-out, the house director will complete
Window(s)
the inspection. Residents
who do not check in or check out by signing this form will forfeit any rights to appeal
Screen(s)
damage billing. The resident signature on this form represents acknowledgment of these statements and agreement to
the initial condition ofShade(s)
the living space.
Ceiling Fan(s)
Maintenance Procedures:
Walls
All residents should report items that are broken or inoperable as soon as possible to the house director.
Floor
Ceiling
Furniture:
Smoke
Detector
Furniture CANNOT
be moved
out of individual rooms. Do not place furniture in hallways or public areas. All
furniture is labeled Light
and, ifFixture
removed, residents will be fined.
Internet Jack
Bed Risers:
Other:
Bed risers are available
on a first-come, first-served basis. Residents requesting a bed riser should come and see the
______________
house director as soon as possible. The fee for a bed riser is $20.
CONDITION OF LIVING SPACE AT CHECK-IN
I, the resident, certify that the check list on the reverse side is an accurate and correct statement of the room condition at
check-in. I accept responsibility for all items and understand that I may be charged for any and all damages upon
checking out of my living space.
Resident Signature: _______________________________________________________ Date: _____________
Resident Name (Printed): __________________________________________________
(Over) ROOM CONDITION REPORT
Complete this form based on the items and condition of your room. If you do not have such items, please mark each as
“N/A.” If you do have such items, please note each as the following: Excellent/New; Good; Fair; or Poor.
If maintenance is required, please report to the house director as soon as possible!
NAME:
ROOM #:
Item
Door
Window Lock
Bed Frame
Mattress/Cover
Desk
Desk Chair
Closet/Wardrobe
Dresser
Towel Rack
(Possibly in closet)
Window(s)
Screen(s)
Shade(s)
Ceiling Fan(s)
Walls
Floor
Ceiling
Smoke Detector
Light Fixture
Internet Jack
Other:
______________
# of Items at
Check-In
Condition at
Check-In
# of Items at
Check-Out
Condition at
Check-Out
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