This document is a permission form for students at Olentangy Liberty Middle School to check out Nook eReaders from the school library. It requires signatures from both a parent/guardian and the student. The parent agrees to be financially responsible for any damage to the Nook or fees from unauthorized content and to ensure its timely return. The student agrees to care for the Nook, not share it, and return it in good condition within the two week loan period.

1. Nook Parent Permission and Acceptable Use Form
Olentangy Liberty Middle School Library has Nook Simple Touch eReaders with downloaded eBooks
available for student check-out, provided through generous funding by the OLMS PTO. The Nook has
helpful educational features: unfamiliar words can be instantly defined using the built-in dictionary,
notes can be typed onscreen, multiple bookmarks can be added, and fonts can easily be enlarged.
Because each Nook is valued at $79.00, we require a parental signature before a Nook Simple Touch
may be checked out to a student.
Parent / Guardian Responsibilities and Permission
I am authorizing my child to check out an eReader from the OLMS library for a two week check-out
period. I understand that it is to be used as a tool for reading and that my child will comply with the
Olentangy Local Schools Acceptable Use Policy. I will help ensure the timely return of the Nook and
will immediately report any problems with the Nook to the OLMS librarian at 740-647-4466. I am
financially responsible for any damage to the Nook as well as charges resulting from any content
downloaded to the Nook, by circumventing the “no wifi” policy.
Nook Simple Touch - $79.00
Case - $29.95
GUARDIAN NAME (printed) ________________________________________________________
GUARDIAN SIGNATURE_____________________________________________DATE_________
GUARDIAN CONTACT INFO (phone and email):________________________________________
________________________________________
Student Responsibilities and Permission
I agree to take care of the OLMS Library Nook while it is in my possession and will use the Nook in an
appropriate manner. I will not give the Nook to another student for his/her use. I will not connect to
any wireless network with the Nook. I will not delete any book or change any settings, nor add any
items to the Nook. I will return the Nook and its case in good condition. I understand that the loan
period is for two weeks ONLY, and will return the Nook sooner if I am finished with my reading. I will
return the Nook directly to a staff member in the OLMS library, and allow time for the staff member to
check the Nook to be sure it is returned in working order.
STUDENT NAME (printed) _________________________________________________________
STUDENT SIGNATURE ________________________________________________DATE______
Grade ______________ Advisory Teacher_________________________
Library Staff Only
Date Item Checked Out:______________________________________
Nook eReader Barcode #______________________________ Staff Initials___________
Date Item Returned:_______________________________________________________________
Item in working order?________ Staff Signature: _____________________________________
This form adapted from an original creation by school librarian Kathy Parker at http://marianslibrary.wordpress.com/