Humanities Department
Textbook Checkout Form
Teacher Name: _____________________________________ Period: __________________
Student Name: ______________________________________
Assigned Textbook Name and Number (with the replacement cost)
Language Arts:
 7th Grade Holt Literature ($87.10) ____________
 7th Grade Holt Handbook ($71.50) ____________
 8th Grade Holt Literature ($87.10) ____________
 8th Grade Holt Handbook ($71.50) ____________
Social Studies:
 7th Grade Glencoe Medieval and Early Modern Times ($60.44) _____________
 8th Grade Glencoe The American Journey ($71.68)
_____________
th
 7 Grade CD-ROM textbook option ($5.00); initial below
_____________
th
 8 Grade CD-ROM textbook option ($5.00); initial below
_____________
 Online textbook option; initial below
_____________
Dear Student and Parent,
Textbooks are expensive and replacement costs for damaged and lost books are not part of a school
district’s budget. Please treat your textbooks with care. Do not highlight passages or write on pages. Any
mistreatment of the textbooks will result in fines. If you are issued a textbook that has writing,
highlighting, or other damage please describe this in detail on the opposite side of this sheet.
We understand that it is the student’s responsibility to return these books in the same condition as they were
issued. We know that we will be held accountable and charged for any loss or damage to this book. Broken
or torn bindings are charged $15.00; torn pages or markings on pages are charged $5-$10 depending on the
severity. Books lost or returned in unusable condition are charged full replacement cost which is listed above
next to the book name.
___________________________
Student Signature
______________________________
Parent Signature
CD-ROM Option:
We understand that the student/ parents have chosen to be assigned a textbook on CD-ROM and will not
receive a paper copy of the book. We understand this requires a working computer with CD-ROM
capabilities which will be our responsibility to provide. We understand this CD-ROM is to be returned when
the student leaves the school or at the end of the school year. We know that we will be held accountable and
charged for loss or damage to the CD-ROM. The charge is $5. _________
Initial
Online Textbook Option:
We understand that the student/ parents have chosen to use the online textbook and will not receive a paper
copy of the book. We understand this requires a working computer with Adobe Acrobat Reader and reliable
internet access which will be our responsibility to provide. We acknowledge that we have received directions
and passwords for accessing this online textbook. _________
Initial
Please describe in detail and damage to the books you currently have issued to you. If needed add
another sheet of paper./Por favor, describa en detalle los daños a los libros que tiene actualmente emitida
a su nombre. Si es necesario agregar otra hoja de papel.
1st Book/ Nombre del 1 libro: ______________________________________________
Describe the condition of the book cover. Are the corners bent or scuffed? /Describir el estado de la cubierta del
libro. ¿Son las esquinas dobladas o rayado?
Is there writing anywhere in the book?/¿Hay escrito en cualquier lugar en el libro?
Are there torn pages or loose bindings?/¿Hay páginas rotas o es la encuadernación suelta o rota?
Please describe any other damage./ Por favor, describa cualquier otro daño.
2nd Book/ Nombre del 2 libro: ______________________________________________
Describe the condition of the book cover. Are the corners bent or scuffed? /Describir el estado de la cubierta del
libro. ¿Son las esquinas dobladas o rayado?
Is there writing anywhere in the book?/¿Hay escrito en cualquier lugar en el libro?
Are there torn pages or loose bindings?/¿Hay páginas rotas o es la encuadernación suelta o rota?
Please describe any other damage./ Por favor, describa cualquier otro daño.
3rd Book/ Nombre del 3 libro: ______________________________________________
Describe the condition of the book cover. Are the corners bent or scuffed? /Describir el estado de la cubierta del
libro. ¿Son las esquinas dobladas o rayado?
Is there writing anywhere in the book?/¿Hay escrito en cualquier lugar en el libro?
Are there torn pages or loose bindings?/¿Hay páginas rotas o es la encuadernación suelta o rota?
Please describe any other damage./ Por favor, describa cualquier otro daño.