Library Card Application
Last Name:
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| First Name: |
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| Middle Name: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Home Phone: |
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| Work Phone: |
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| Date of Birth: |
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Permanent Address
(if different from above) |
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| D.L. # or I.D. # |
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| Email address: |
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To be completed by parent or guardian if applicant is under 12.
I am willing to allow my child to borrow materials from the public library. I will be responsible for their proper use and will pay all fines justly charged.
Parent / Guardian Signature: __________________________________________