Friends of The Resource Place Membership Agreement
Please complete the following form to become a member of The Resource Place Lending Library. Membership is free to all licensed and exemption child care providers. A copy of a Center/Home/Group Home License or Exemption Letter is required to obtain a free membership.
Member Information
Individual Demographics
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home/Mobile Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Driver's License Number
*
Front of Driver's License
*
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Back of Driver's License
*
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Program Information
Please provide your employer/program information.
Name of Employer/Program
Work Phone Number
Please enter a valid phone number.
Are you a NEW or Renewing member?
New member
Renewing Member
Program Type
Licensed Child Care Center
Exempt Child Care Provider
Family Child Care Home
Group Child Care Home
Head Start/Early Head Start Parent
Homeschooler Parent
Individual
Are you a Child Care Subsidy Provider?
Yes
No
Title/Position
Please Select
Center Director
Center Teacher
Group/Home Provider Owner
I am presently working with children ages
Please Select
Infant
Toddler
Pre-School
School-Age
Upload current Child Care License or Exemption Letter to receive a free membership.
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Membership Agreement
All Resource Place patrons and visitors are required to sign in and out when visiting the facility. You are responsible for any and all Resource Place materials (including toys, videos, books, cassettes, computer disks, or modules) borrowed on your membership, with or without consent. Card holder will be billed for damaged or lost items. Collection will be sought to replace items in the event of failure to adhere to lending policies. Return Resource Place materials on time and in good condition to a representative of The Resource Place. REPORT LOSS OF MEMBERSHIP CARD OR CHANGE OF NAME OR ADDRESS IMMEDIATELY. You membership may be revoked by The Resource Place at any time.
Acceptance of Membership Terms
Please place your name and the current date in the fields below if you accept the Membership Terms stated above.
Signature
*
Today's Date
-
Month
-
Day
Year
Date
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