Fillable Form 6: TEXTBOOK LOAN FORM This Form is

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CAPITAL REGION BOCES
TEXTBOOK LOAN FORM
FOR ADDITIONAL
INFORMATION
CONTACT
6
British
American
Blvd,
Suite
102
John
Florussen
or Mark
English
Latham,
NY
12110
Phone: (518)
464-5123
Fax: (518) 464-5122
To be completed by Parent or Guardian
www.capitalregionboces.org/textbooks
This Form is DUE: June 1
john.florussen@neric.org
/ mark.english@neric.org
T o: Non-Public School:
(School
District of
Residence)
Student Name:
Grade:
Date of Birth :
Home Address:
NY
(Street and Number)
(City)
(Zip)
Contact Phone :
Email :
(By
including your
email
you
consent to receive
emails
regarding your
child’s
textbooks
from
the
Capital
Region
BOCES)
Application
is hereby
made
for the
loan
of
the
textbook
materials listed
below.
I understand
that all
books are
to
be
maintained
in
good
condition,
and
that,
if
damaged
or lost, the
book(s) will be
replaced
at my
expense.
I also
understand
that the
books must be
returned
to
the
Capital Region
BOCES
or any
official designated
as the
custodian
thereof
upon
request.
If
my
child
should
transfer
to
another school,
the
books will be
returned
to
the
Capital Region
BOCES
or I
will make
arrangements
with
the
BOCES
for their return.
Date: Signed :
AFTER COMPLETION
OF THIS
FORM,
NOTIFY US
IF
THERE IS
A
COURSE CHANGE,
OR IF
THE STUDENT
WILL
NOT
ATTEND THIS SCHOOL.
YOUR DISTRICT
MAY REQUIRE
THAT
YOU REGISTER YOUR CHILD WITH THEM.
CONTACT
THE REGISTRAR,
OR CALL
US FOR CONTACT
INFORMATION.
PLEASE FILL I
N
ALL CO
LUMNS BELOW:
Course/Subject ISBN Publisher Title
:Date:
NON-PUBLIC SCHOOL OFFICIAL:
I certify that the books listed above are required in a particular class or program as a primary source of study material intended to implement a major part of an approved curriculum taken by the
student listed above
who is registered in the non-public school listed above.
Signed
accessible 1/18
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Completed 15 September 2021

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