To register for a library card you will need to complete this form and stop into the library to provide proper identification, as required by the issuing library. The information on this form is solicited to obtain a complete list of library patrons and will be used solely to record the location of library books and property.

If you have a printer attached, you may print this form, before pressing the "Submit" button. Bring the printout with you when you go to your library to pick up your card.

*REQUIRED INFORMATION

*Name
First Full Middle Last

*Mailing Address
Street Apt. P.O. Box
City State Zip Code

Other Address
(year round) (seasonal)
Street Apt. P.O. Box
City State Zip Code

 
Home Phone () - Work Phone () - Ext.

 
E-Mail Address Birth Date - Month Day Year

 
I agree to be responsible for material borrowed with this card, for all the fines incurred, and for loss and damage of material charged upon it. I release the library from any liability for damages occurring from equipment or material I have borrowed. *Parents MUST Sign for Patrons Under Age ___
I agree to be responsible for materials borrowed with this card, for all fines incurred, and for loss and damage of material charged upon it. I release the library from any liability for damages occurring from any material or materials borrowed. I accept responsibility for the selections of materials made by this person. This may include access to electronic resources such as the Internet.
________________________________
Signature		 ________________________________
Signature of Parent or Guardian
________
Date		 _________________________________
Printed Name of Parent or Guardian
________
Date

Please provide the following information. It will be used for STATISTICAL purposes only.

Age:
Sex:
Preferred reading language: If other, please explain: