Youth Library Application

Child's First

Middle

Child's Last

Suffix

Child's Date of Birth

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

County

County of Residence

School District

Parent's Phone

Parent's Email

4 Digit Pin#

How would you prefer your notices?

Printed/Mailed

Texted

Emailed

I agree to the terms of service.

Parents or guardians are responsible for monitoring the reading, listening and viewing choices of their children. I assume full responsibility for the use of this card and all charges associated with its use. I give permission for you to contact me by phone and email about my child's library account.

Internet Use

I agree to the terms of use. I do want internet access for my child

I do want internet access for my child

I do not want internet access.

Parent's First

Parent's Middle

Parent's Last

Suffix

Signature of Parent

Sign above

Parents Valid ID

Parents Valid Government ID

Parents ID Expiration Date

Today's Date