Classroom Collections Reservations

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Name
First Last
School Name*
School Address*
Street Address Address Line 2 City State ZIP Code
Home Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Subject taught*
Grade Level Taught*
RESERVATION
Anne Frank Collection - $25.00
Price: $25.00 Quantity:
Night Collection - $25.00
Price: $25.00 Quantity:
Local Survivor Collection - $25.00
Price: $25.00 Quantity:
Date Range Preference #1*
Date Range Preference #2*
Date Range Preference #3*
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
IMPORTANT INFORMATION ABOUT YOUR RENTAL: Collections may be picked up in the MCHE office after 8:30 am on the first day of each loan cycle and must be properly assembled and returned no later than 5:00 pm on the last day of the cycle. In requesting the loan of these resource collections, the teacher named above and/or the school or school district agree(s) to the following: Chests will be housed in the classroom of the requesting teacher and will remain secured when unsupervised. All copyrights will be honored. I agree to the conditions stated above and understand that I am financially responsible for replacement of missing or damaged materials from the chest.

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