First Name:

Middle Name:

Suffix (Jr, Sr, etc.):

Birthdate:   Month: Select 01 02 03 04 05 06 07 08 09 10 11 12    Day: Select 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     Year: Select 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993

Address:

City:   State:   Zip:

Phone: Area code first, no spaces or dashes

Mother's First Name (for identification):

E-mail address*: (Leave blank if none)

Age: 0-11    12-17

Parent/Guardian/Sponsor

Last Name:      First Name:

Address:

City:   State:   Zip:

Home Phone: Area code first, no spaces or dashes

*Submission of e-mail address will result in notifications four days before items are due, when they are overdue, and when items placed on hold are available for pick-up.

I accept responsibility for all materials charged to this card with or without my consent. I agree to observe all library rules; to promptly pay all charges; and to notify the library of any changes to this information.

I understand that all library materials, including books, audiovisual items, electronic databases and the Internet (World Wide Web), are available to all library users. I understand that I am responsible for my child's use of all library materials, including the Internet.