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Teacher:___________________________________________ Class:_______________________ Year:___________

Textbook Checkout Form


4-Excellent 3-Good 2-Fair 1-oor
Is NEW or looks almost like
NEW; binding is intact; slight
wear on cover; few page
folds; almost no stray
marks; highly usable
Looks good; binding has
light wear and tear; small
creases on cover or pages;
few stray marks; very
usable
Looks OKdecent; binding is
slightly coming apart; cover
looks olddirty; pages are
tornwrinkledwritten on;
usable
Looks really bad; binding is
signi!cantly damaged; cover
is rippedfalling o"; pages
missing; barely usable;
needs to be replaced
#e$tbooks%&s must be treated carefully at all times' It is understood that normal wear and tear on te$tbooks occurs( for
which a !ne is not issued' )owever( obvious damages to the binding( cover( andor pages of the books( as well as
signi!cantly crackedscratched %&s( depreciates the condition of these materials and a !ne will be issued as stated below'
*#he cost of the %&+,O- is the same as the cost of the te$tbook' . lost te$tbook%&+,O-/ 0ully cost 1 23 shipping charge4'
!ame o" #tudent $ook
%
&ssued at
'e(el ___
#tudent)Teacher
#i*nature
+eturned at
'e(el __
C,-
+-.
Fine
Char*ed
5'
6'
7'
8'
3'
9'
:'
;'
<'
5='
55'
56'
57'
58'
53'
59'
5:'
5;'
5<'
6='
65'
66'
67'
68'
63'

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