The LRC      

 

Loss of Material Form

 

 

Student Name: _______________________________________

 

Title of Lost Material:  __________________________________

 

 

I looked for this title in the following places:

 

            ___ In my bedroom   ___ In the car            ___ Under the sofa

 

            ___ In the playroom  ___ In the kitchen      ___ Behind the washer

 

 

My parents (or legal guardians) have helped me try to find this title, but we did not find it.  We have looked in all possible - and unusual - places, but we have had no luck with our search.

 

___________________       ______________________              _____________

    Student Signature              Parent/Guardian Signature                   Date

	For LRC Use only:     Received: _________ Cost:         _________ Reordered:_________