Child and Parent Programs Lending Library Registration Client Category (Please check one) Family ECE Student Childcare Workforce Childcare Provider Other Name* First Last Facility Name Address* Street Address Address Line 2 City Province/Region Postal Code Country 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 Municipality* Phone Number* Email* By typing your name here you are acknowledging this as your signature.* Resource Lending AgreementThis resource lending agreement is between you and the North Shore Child Care Resource & Referral Program. Resources included in this lending agreement are the library, equipment, large toys and activity boxes. The borrower agrees to take sole responsibility for all resources borrowed from the North Shore Child Care Resource and Referral Program. It is the borrowers responsibility to use all equipment/materials as per the manufacturer’s guidelines or for the intended purpose. The library user must ensure that all resources are returned thoroughly cleaned with disinfectant (a 1 part bleach/10 part water solution) on applicable items and in good working condition. If an item is damaged or lost the borrower is responsible for replacing the damaged, or lost item and will pay the replacement value. The borrowing period is 3 weeks. As per our CCRR policy, borrowers are responsible for replacement costs of lost or damaged resources. If you are unable to return missing items 30 days after the due date, you will be responsible for the cost of the item. I would like to receive the Child Care Resource & Referral (CCRR) newsletterAs per the Personal Information Protection Act, information collected will be used only as necessary to deliver CCRR services, and will not be disclosed to a third party without your permission.Maximum number of items per categoryBooks: 10 Story Kits: 2Felt Stories: 3 Toys: 5 Puppets: 3 Equipment: 2 Loose Parts: 1 Bag The borrower has read and understood the guidelines pertaining to the usage of the resources borrowed. The North Shore Child Care Resource & Referral Program is not responsible for any injury to persons or damage to property that may arise through use of borrowed resources.Consent* I acknowledge my responsibility and obligation in the resource lending agreement by my signature.NameThis field is for validation purposes and should be left unchanged.
