Resource Check-Out Form
I agree to return these materials within the designated amount of time, and if they are lost or damaged while checked out to me, I will pay to repair or replace them. |
Today’s date _____________________ Current time _________________ |
Signature ________________________ Student I.D. # ________________ |
Printed name _________________________________________________ |
Address _____________________________________________________ |
City __________________________________ Zip Code ______________ |
Telephone number _____________________________________________ |
Alternate telephone number ______________________________________ |
VIDEOS (may be checked out up to 3 days) and |
Title #1 ____________________________________________________ |
Title #2 ____________________________________________________ |
BOOKS (may be checked out up to 14 days) |
Title #1 _________________________________________________ |
Title #2 _________________________________________________ |
Date checked back in ________________Checked in by ____________ |