\documentclass{article}

\title{SIPB Library Signout Sheet}
\author{Alex Dehnert, SIPB Vice-Chair}
\date{Monday, March 11, 2013}

\usepackage[margin=1in]{geometry}
\usepackage{setspace}

\newcommand{\signoutline}{
\underline{\hspace{2.5in}} \underline{\hspace{2.5in}} &
\hspace{1in}               \underline{\hspace{1in}} &
\underline{\hspace{1.5in}} \underline{\hspace{1.5in}} &
\hspace{1in}               \underline{\hspace{1in}} \\\hline
}

\begin{document}

\maketitle

By signing out this book, I acknowledge having the read the posted
policies. I acknowledge that if I lose a book or fail to return it on
time, the SIPB Vice-Chair may take such steps as he deems necessary to
retrieve that book (or a new copy), or sufficient fines to replace it.

\bigskip

\setstretch{1.5}
\setlength{\parindent}{0in}

\begin{tabular}{|p{2.5in}|p{1in}|p{1.5in}|p{1in}|}
\hline
  Title \& Author & Date out & Borrower \& Signature & Date in \\\hline
\signoutline
\signoutline
\signoutline
\signoutline
\signoutline
\signoutline
\signoutline
\signoutline
\signoutline
\signoutline
\signoutline
\end{tabular}

\end{document}
