Last Name:      First:      MI:

Address:

City: State: Zip:

Home Phone: Area code first, no spaces or dashes
Work Phone: Area code first, no spaces or dashes  

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

Age: 0-11    12-17

Parent/Guardian

Last Name:      First Name:

*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.