Our Sensory Lending Library provides families with the opportunity to access sensory items on a two-

week lending period. The intent is for families to utilize these items in a home setting to gage interest.

Hours of Operation: Mon 9am-4pm, Tues 9am-1pm, Wed 9am-7pm and Thurs 9am-1pm.

Checking out Items: Individuals are able to borrow a maximum of three items at a time from the Autism
Ontario Sensory Lending Library, dependent on need, availability and the discretion of the employees and
volunteers of Autism Ontario. All items can be checked out for a period of two weeks. Items checked out
are the responsibility of the individual and need be returned in the same condition they were received. If an
item is damaged, please immediately contact: Livia Congi at livia.windsor@autismontario.com

Fees: The Sensory Library is free to members of Autism Ontario and a $10 charge for non-members per
checkout. At the time of checkout, a $50 cash deposit or credit card is required as a measure to ensure all
items are returned.

Late Fees: There will be a $1.00 late fee per day per item that is not returned on time, which will go to the
purchase of additional items for the Sensory Library.

It is recommended that you (the participant or guardian) consult with your Physician or Occupational
Therapist prior to the start of any material being borrowed. By registering for or participating in an Autism
Ontario program or borrowing materials, the participant agrees that the participant is and will be voluntarily
participating in these activities and the participant assumes all risks of injury or death, which might result
from these activities.

Name:_______________________ Signature: ________________________ Date:_______________

I acknowledge and understand that supervision of children/youth is the sole responsibility of

parents/guardians and caregivers and release Autism Ontario, its employees, officers, director and agents
from all claims arising from any accident, death or injury which is caused by or arises from participation in
any Autism Ontario event.

Name:_________________________ Signature: _____________________ Date:________________

I have read all of the above and agree to all of its terms. By signing this statement, I agree to be held
responsible for all items checked out by me for my child.

______________________________________________________________________________________
Parent/Guardian Signature Date

1168 Drouillard Rd. Windsor, ON N8R 1Y2 – 519-250-1893

 Sensory Lending Library Information Sheet
□ Parent/Guardian □Professional

Last name: __________________________ First name: ________________________________

Child’s name: _________________________________ Birthday: _______________________

School: _______________________________________________________________________

Email address: _________________________________________________________________

□ Please check the box if you would like to receive our newsletters.

If you are a professional, please check the appropriate box: □ Teacher □ OT □ Speech Pathologist
□ Respite Worker □ Other: _________________________________

Are there any items you think should be added to the Sensory Library?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

1168 Drouillard Rd. Windsor, ON N8R 1Y2 – 519-250-1893

 Sensory Lending Library Check in/Check out Form

Date Checked out: ________________________________________

Due Date: _______________________________________________
Date Returned: ___________________________________________
Late Fee (if applicable):_____________________________________
Returnable deposit of $50 paid by: □ Cash □ Credit Card
(see attached form-credit card will not be charged unless damage has occurred to items borrowed)

Name of Items and log number checked out:

1. ________________________________________________________________________________
________________________________________________________________________________
2. ________________________________________________________________________________
________________________________________________________________________________
3. ________________________________________________________________________________
________________________________________________________________________________

*All items must be returned in the condition in which they were lent out. If an item is damaged or broken
while checked out, it is the responsibility of the borrower to cover any replacement costs. Initials: ______

I have read all of the above and agree to all of its terms. By signing this statement, I agree to be held
responsible for all items checked out by me for my child.

______________________________________________________________________________________
Parent/Guardian Signature Date

Autism Ontario employee/volunteer who checked out the items:__________________________________

1168 Drouillard Rd. Windsor, ON N8R 1Y2 – 519-250-1893