SAMPLE

Textbook Card XYZ Charter 20__-20__

Name of Pupil ___________________________ Grade __________ School _____________________________

Address ________________________________ Parent Name ________________________________________

List of Books	Book No.	Condition Issued	Condition Returned	List of Books	Book No.	Condition Issued	Condition Returned
Arithmetic				Science
Civil Government				Social Studies
Dictionary				Spanish
Art				Spelling
Handwriting				Vocal Music
History				Band
Homemaking				Orchestra
Language & Grammar				General Shop
Literature
Physiology
Readers-Basal
Readers-Supply

I certify that the pupil’s record on these books is clear.

____________________________________Teacher _____________________________________Principal

This card is to be kept by the Inventory Clerk during the school term. When all books have been returned or paid for, it should be signed by the Inventory Clerk and given to the pupil as a receipt.

Textbook Card XYZ Charter 20__-20__

Name of Pupil_____________________________ Grade__________ School____________________________

Address___________________________________ Parent Name______________________________________

List of Books	Book No.	Condition Issued	Condition Returned	List of Books	Book No.	Condition Issued	Condition Returned
Arithmetic				Science
Civil Government				Social Studies
Dictionary				Spanish
Art				Spelling
Handwriting				Vocal Music
History				Band
Homemaking				Orchestra
Language & Grammar				General Shop
Literature
Physiology
Readers-Basal
Readers-Supply

I certify that the pupil’s record on these books is clear.

_______________________________________Teacher ___________________________________Principal

This card is to be kept by the Inventory Clerk during the school term. When all books have been returned or paid for, it should be signed by the Inventory Clerk and given to the pupil as a receipt.

IV. 3