Guidelines:

• We need 5 week-days notice to pull books.
• Both fiction and non-fiction items.
• For grades Preschool to 8th.
• Items will be checked out for 3 weeks.
• Holds materials 2 days past the pick-up day.
• A maximum of 35 books may be requested.

Fields marked with an asterisk are required. *

Date of Request: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20112012201320142015

Date to Be Picked Up: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20112012201320142015

Name of Teacher: *

Library Card Number:

Leave blank if the teacher does not have a library card.

School: *

Grade: *

School Phone Number: *

Number of Items You Would Like to Receive: *

Materials Needed: * Please describe the types of materials you would like to request.

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.