Home and Hospital Teaching
Books and Materials Checkout Form

The Home and Hospital Teacher, upon pick-up and receipt of any materials from schools, should fill out the Title column (materials description) and initial/date the Checkout column before leaving the building.

Upon returning the materials to the school, the staff member to whom the materials were returned, should initial/date the Check-In column.

Once the assignment is complete, the Home and Hospital Teacher should complete the bottom portion of the form and return it to the Home and Hospital Secretary to be placed in the student's file.

Title	Check Out Home Teacher Initials and Date	Check In Office Staff Initials and Date

H/H FORM 2