GPFS Music Library Check-Out Form


Check-Out Date:
Due Date:

Extension #1
Due Date:
Extension #2
Due Date:
       


   
Name:
   
Address:
   
City, State, Zip Code:
       
Phone (Home): Phone (Work or Cell):
   
E-mail Address:

I want to check out the following items:

By signing this form, I agree to follow the GPFS Music Library Rules of Use:

  1. Up to ten (10) selections may be borrowed at one time, for a period of up to thirty (30) days. The due date will be stated clearly to borrower at the time of check out. It is the borrower's responsibility to take note of the due date and either return the borrowed items on or before that date, or contact the Librarian with a request for an extension of the check-out period. Late fees of $1.00 per item per day will apply in the case of returns or extension requests that occur past the due date for borrowed items.
  2. The due date may be extended up to two (2) times, if the items have not been reserved by another member. Extensions may be obtained with the approval of the Librarian via e-mail or phone. The total check-out period should not exceed ninety (90) days.
  3. Refundable deposit:

    1-5 items require a $50.00 deposit
    6-10 items require a $100.00 deposit

  4. A personal check payable to GPFS for the designated amount listed above will be given to the Librarian prior to borrowing items from the GPFS Music Library. If the replacement cost of the borrowed music is higher than the above deposit amounts, the replacement cost will be collected as a deposit. The deposit is to insure the return of all borrowed items in good condition on or before the due date.
  5. Upon return of all items in good condition by the due date, the deposit check will be returned to the borrower.
  6. An amount equal to the replacement cost of music damaged by the borrower or music not returned by the due date-along with any overdue fees-will be either collected from the borrower or deducted from the deposit check with any balance to be refunded by the GPFS Treasurer.

 


Signature
 

 


Date

 


Parent's Signature, if Borrower is under 18 years of age
 

 


Date