Toy and Resource Lending Library Membership Registration Form *Please be sure to fill out all mandatory fields. Parent/Guardian InformationParent/Guardian Name* First Last Relationship to Child:* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Cell PhoneEmail* Children's InformationNumber of Children:*Please complete the following information for all of your children.First NameLast NameAge Click the + sign to add more children.Mission/Aggasiz/Harrison Program you are affiliated with (Include Name of Program and Name of Facilitator/Coordinator): Toy and Resource Lending Library Agreement between MCSS Child Care Resource and Referral (CCRR) and parent/guardian in this form. For the purposes of this agreement, all items available (toys, puppets, games, playsets, books, audio-visual materials, and other resources) will be referred to as “resources”. This is a loan agreement only. The CCRR retains full and complete ownership of any product or item(s) being used by the undersigned.* Select All I hereby agree that I will be the sole user of the borrowed item(s). I agree to release, save harmless, and indemnify the CCRR and/or it’s agents from and against all claims, actions, costs, expensed and demands in respect to death, injury, loss or damage to person or property, arising out of, or in connect ion to the lending of resources from the CCRR. I understand that it is my responsibility to ensure all pieces are present and in good condition. If there are discrepancies, I will notify the CCRR within 48 hours. I agree to use the resources appropriate to the children’s ages and only under the supervision of an adult. Items will be used with the recommended ages only. I agree to periodically inspect the items for damage. If damage is found I will remove the item immediately and return it to the CCRR. I agree to return all resources in good, clean, useable condition on or before the designated due date I agree that I am responsible for the replacement of any resources I have lost or damaged. The replacement cost will be determined by the CCRR. I understand that in the event that I have any outstanding fees or repair/replacement charges, lending privileges will be suspended until all fees are paid in full I have read and agree to abide by the Toy and Resource Lending Library Guidelines I, the undersigned, acknowledge my borrowing privilege, responsibilities and obligation in this by my signature.Member's Signature*Date MM slash DD slash YYYY
