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* Required information.

Library Card Application

Applicant Name


Last Name *
First/Middle Name *
Age *
Birth date if under 18

Parent/Guardian (if under 18)


Last Name
First/Middle Name
Library Card Number
Relationship

Mailing Address


Address *
Apt./Unit #
City *
State *
Zip Code *

Physical Address (if different from mailing address)


Address
Apt./Unit #
City
State
Zip Code

Contact Information


Phone Number (XXX-XXX-XXXX) *
E-mail Address

By submitting this electronic application, I (or my child) agree to comply with all library polies, accept responsibility for all materials borrowed and will give immediate notice of any change of address.  If my library card is lost or stolen, I understand I must notify the library immediately.  I understand that children have access to all materials in the Library, and I accept responsibility for monitoring my child's access to print, media, and electronic formats, including the Internet.