Date to be picked up:

-- mm/dd/yy

Please provide the following information:

Card Holder Name
Phone

Please provide the following information about your child:

Name
Age
Grade	K 1 2 3 4 5 6
Gender	Boy Girl

Will you need a loan period of more than 2 weeks? (Items may not be checked out for longer than 28 days.)

Yes
No

Reading levels (choose one):

j-P - Picture Book
j-E - Beginning Reader or 1st - 3rd grade
j-F - 3rd to 6th grade

All materials are selected according to child's age, reading level and interests.  What type of materials would you like in your personalized travel tote kit?  (Videos and DVD's are not included in Travel Totes.)

Audio Materials (check the formats you prefer):

Fiction books on Cassette  Paperback with Cassette    
Music on CD                

Non-Fiction Books (check the subjects that interest you):

Wild Animals  Sea Animals   Pets          Birds       
Reptiles      Dinosaurs     Farm Animals  Other       

Transportation:

Car     Trucks  Trains  Planes
Other   

Sports:

Baseball        Football        
Soccer          Golf          
Basketball      Volleyball      
Extreme Sports  Skate Boarding
Other           

Arts and Crafts:

Music    Dance    Crafts   Drawing
Other    

Rhymes:

Poetry   Riddles  Jokes    Other  

Biographies:

Men    Women  Both   

Fiction Books (check the types of books you like to read):

Adventure          Mystery            
Sci-Fi             Historical       
Fantasy            Caldecott Winners  
Newbery Winners    Animal           
Magazines          

If you would like materials on your destination, let us know where you are going.

Select no more than 2 of the following activities you would like included in your tote:

Word Search      Hidden Pictures  
Mazes            Coloring Pages