Child Care Connections' Lending Library Sign-Out Form

Name: ________________________________________________________

Program Name: ________________________________________________

 Family Child Care    Child Care Center     Other: _______________

Home Address: ________________________________________________

City: ____________________________________ Zip: ________________

Home Phone: __________________  Work Phone: __________________

Titles Signed Out:

1. __________________________________________       Book    Video

2. __________________________________________       Book    Video

3. __________________________________________       Book    Video

I understand:

Ø      I may borrow these materials from Child Care Connections for three (3) weeks.  I may request an additional week, which may be granted at the discretion of the Training Department. 

Ø      I am responsible for the purchase price of these materials if they are lost, stolen, or significantly damaged.  Child Care Connections reserves the right to restrict library usage if materials are mistreated.  

Signature: _____________________________________  Date: _________

Due Date for Materials: _________________________________

Child Care Connections

136 U.S. Route 1

Scarborough , ME 04074

396-6566

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