Youth Services Material Request Form




(*)Indicates a required field


Please submit one form for each item you are requesting.
You will receive an email confirming your submission and request.
For immediate use, the item will be sent within 5 business days if it is available.
For long range requests for future use, the item will be sent shortly before the date requested.


1. Select Your Library (*)

Please make a selection: 1. Select Your Library
2. Contact Name (*)

Please complete: 2. Contact Name
3. Contact Email Address (*)

Please complete: 3. Contact Email Address
4. Phone Number Where We May Contact You (*)

Please complete: 4. Phone Number Where We May Contact You using this format: 123-456-7890
5. Type of Item Requested (*)

Please make a selection: 5. Type of Item Requested
6. Please Enter the Item's Barcode (*)

Please complete: 6. Please Enter the Item's Barcode
7. Please Enter the Item's Title (*)

Please complete: 7. Please Enter the Item's Title
8. May We Substitute? (*)



Please select YES or NO.

8. May We Substitute?

9. Program Theme (Example: Pets, Alphabet, Spiders) (*)

Please complete: 9. Program Theme (Example: Pets, Alphabet, Spiders)
10. Age Group (*)

Please make a selection: 10. Age Group.
11. Date Requested for Use (*)


Please complete: 11. Date Requested for Use. Navigate through the calendar using left or right facing arrows. When you click on a date it will automatically populate the field.
12. Any Special Instructions?

12. Any Special Instructions?
Enter the CAPTCHA text (*)
Enter the CAPTCHA text
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Please type the jumbled letters you see above the text box. (This is called the CAPTCHA code.)



 
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