Health Education Library

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Library Registration

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Registered borrowers receive:

materials for four-week loan anywhere in California
electronic communication and materials (e.g., newsletters, promotional items)
monthly e-mail updates highlighting new and popular resources, trainings, and news

Please enter the following information. Click the Submit button at the bottom of the page when you are done.

Personal Information: (Required)

First Name:	M.I.:	Last Name:
Home Address:
Address Line 2:
City:
Zip/Postal Code:
Telephone:	Fax:
E-mail:
Customer Account Number, if any:

Professional Information: (Required)

Job Title:
School/Institution:
Business Address:
Address Line 2:
City:
State:		Zip/Postal Code:
Business Telephone:		Business Fax:
Name of Your Supervisor:
County:

Confirm Registration: (Required)

Confirm my registration via:

U.S. Mail

FAX

E-mail

Terms and Responsibilities: (Required)

The California Healthy Kids Resource Center will package and send items to you via UPS. CHKRC pays to send materials, borrower pays to return materials (average cost $4-12). Please save the shipping box to return materials.

Borrowers are responsible for the care and return of materials.
Completing the registration form indicates the undersigned borrower promises to:

Care for and guard borrowed materials.
Accept responsibility for materials damaged while in your possession, i.e. voluntary liability.
Indicate if material is damaged or not in useable condition.
Return materials ON OR BEFORE return date, so others receive materials in a timely manner.
(Please allow 3-5 business days for shipping.)
Provide adequate protective packaging for shipping,
(tip: save and reuse original shipping box and packing material).
Insure and return materials via UPS or other traceable service.
Provide full replacement cost for any materials lost or damaged while in your possession.
Assume total responsibility for safe and appropriate use of borrowed library resources. The borrower shall use best efforts to ensure that all recipients of these programs meet the minimum standards to participate without injury.
Respect that the video, CD-ROM, curriculum programs, and other materials provided by the center are protected by copyright laws and that unauthorized reproduction constitutes a violation of United States copyright laws.

I agree to the Terms and Responsibilities described above.

Yes

I would like to receive electronic updates of new materials and trainings in the following areas:
	Alcohol and Other Drugs	Comprehensive Health Education
	Growth and Development	Health Services
	Mental, Emotional, and Social Health	Nutrition
	Nutrition Services	Personal and Community Health
	Physical Activity	Program Administration
	Sexual Health	Tobacco

Date: 07/30/2010

www.californiahealthykids.org
This Web site does not necessarily reflect the
position or policy of the CDE or CDPH.
All rights reserved.
Phone: 510-670-4583
Toll Free: 888-318-8188
Fax: 510-670-4582
Send questions and comments.