Youth/Teen Library Card Pre-Registration

Patrons over 18 years old must use the Adult Form.

Last Name:

First Name:

Middle Name:

Suffix (Jr, Sr, etc.):

Birthdate:

Month: Day: Year:

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.