109-AR-7. PARENT REQUEST FOR RESTRICTED ACCESS TO RESOURCE MATERIALS Form
This form pertains to library books. A parent/guardian may opt to restrict the access of their child to a particular title by submitting this form to their school librarian. Upon receipt, all requests will be incorporated into the library circulation software system. Restrictions will remain in place until otherwise notified by a parent/guardian.   
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Date of Request *
Student Last Name *
Student First Name *
Student's current grade *
For ELEMENTARY ONLY, who is the student's classroom teacher?
Current Building *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian Email *
Please list the specific title(s) and author(s) of any library book(s) for which you are requesting to restrict access for your child. *
Example formatting: Harry Potter - Order of the Phoenix by J.K. Rowling
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