| Last Name |
First Name |
Middle Name |
Suffix (JR, SR, etc.) |
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| Birthdate YYYY MM DD (for example, 19500829 for August 29, 1950) |
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| Street Address (include Apt. or Lot # if applicable) |
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| City |
State |
Zip + 4 |
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| Phone Number |
County (user cat 1) |
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| PO Box (if mailing address) |
City |
State |
Zip Code + 4 |
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| E-mail Address (used for library notification only - including overdue & reserve notices and library news & announcements ) |
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| For juveniles using parent/guardian ID: |
| Parent/Guardian First Name |
Parent/Guardian Last Name |
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FOR CHILD'S APPLICATION ONLY:
I do not want my child to check out R-rated videos. I certify that my child is under age 17.
I understand my child will be able to check out PG videos, PG-13 videos, non-rated videos, and any other library materials.
No information in your confidential Library records will be disclosed to a third party except in accordance with proper judicial order.
We cannot disclose your confidential Library records to you over the phone without proper identification.
I agree to give immediate notice of change of address, loss of card, and loss of library materials. I will be responsible for all fines or other charges imposed for late return, loss, damage or mutilation of material borrowed on my card. If my card is lost or stolen, I am still responsible for all materials charged to my card until I report such loss to the library staff. |
Library Use Below This Line
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Borrower's Signature (Parent/Guardian Signature) |