Materials Loan Agreement 2011-12

Please fill out this form if you are a teacher participating in the Splash Elementary Program in 2011-12.

I acknowledge financial responsibility for the following Splash Program Materials valued at a total of $445.00.

Investigating Vernal Pools Teacher’s Manual ($125.00)
Critter Catalog ($150.00)
Flower Facts ($150.00)
Splash Video or DVD ($10.00)
Fairy Shrimp Pan ($10.00)

I acknowledge that these materials are on loan to me without charge.  I agree to provide Splash with my complete contact information (including home address and phone) and to inform the elementary program coordinator when it changes.

I have read and understood the Splash Teacher Expectations Agreement.  If I am unable to meet one or more of the tasks listed in the Teacher Expectations Agreement, I agree to inform Splash immediately and, if necessary, to return the above-listed materials to a Splash representative.

I agree to surrender the materials within 30 days upon request by a Splash representative. If I do not return the materials within the allotted time, I understand that Splash will issue an invoice in my name for the listed value of each item up to a total of $445.00 to be paid within 30 days.

Name: *

School: *

Email Address: *

Teacher's Manual Serial #: * V3-

The serial numbers are on the label on the inside, front cover of your binders.

Critter Catalog Serial #: * V3-

Flower Facts Serial #: * V3-

Notes:

Agreement: *

I agree to these terms and conditions.

Please type these numbers into the box to verify that you are not a machine.: * 57980680676391 »