CKLS Youth Services Material Request Form

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Please submit one form for each item you are requesting.
You will receive an email confirming your submission and request.
For long range requests for future use, the item will arrive approximately 7-10 days before the date requested.

Email *

Select Your library (Click "choose" below to make your selection) *

Contact's name *

Phone number where we may contact you (123-456-7890) *

Type of item requested (Click "choose" below to make your selection) *

Item's Barcode (begins with the digits 37434) *

Item's title *

May we substitute? *

yes

Program theme (Example: Pets, Alphabet, Spiders) *

Please select an age group (Click "choose" below to make your selection) *

Date requested for use (Please note the date you will be using the item, we will make every effort to supply this item to you 10 days ahead of your planned program date.) *

YYYY

Any special instructions?

Comments

I, (signed below) agree to the terms of use stated above. *

A copy of your responses will be emailed to the address you provided.

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