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Juvenile Library Card Application

4. First Name*

5. Last Name*

7. Address1*

9. Address2

11. City*

12. State*

13. Zip*

15. School Attended

16. Birthdate*

18. Telephone Number

    Home Phone

19. Telephone Number 2

    Mobile phone number

20. Telephone Number 3

    Contact number

24. Parent or Guardian information
    Children under the age of 14 without a HS ID card must have a parent or legal guardian accept responsibility for their library use.

    Children under the age of 14 without a HS ID card must have a parent or legal guardian accept responsibility for their library use.

26. First Name of Parent or Guardian*

27. Last Name of Parent or Guardian*

29. ID number from picture ID (i.e Drivers License)*

    Please input your ID number

30. Birthdate*

32. Email Address

    Input your email address

34. Reference*

    Name and phone number of someone who knows you but does not live with you.

36. Consent to receive information

    1. Receive a friend request from the Library Facebook page
    2. Receive the Library's monthly calendar via email
    3. Receive special notices of library programs via email

    Check the boxes for the information you wish to receive.

38. Acceptance of Responsibility*

    1. I accept full responsibility for any library materials checked out on this card

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field