Student Library Card Application
Student's Name
*
First Name
Middle Name
Last Name
Student's Date of Birth
*
-
Year
-
Month
Day
4 digit year, 2 digit month, 2 digit day
Date
School student is attending
*
Greensburg Elementary School
Greensburg Jr. High School
Greensburg High School
North Decatur Elementary
North Decatur Jr/Sr High School
South Decatur Elementary
South Decatur Jr/Sr High School
Good Shepherd Christian Academy
Grade
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Driver's License or State ID #
*
Phone Number
*
-
Area Code
Phone Number
Email address (used to notify of late items or hold requests)
example@example.com
Check below if you would like to receive the Library's monthly eNewsletter featuring programs, events, and new materials.
Yes, I would like to receive the eNewsletter in my email.
Student Mailing Address (Library card will be mailed to this address)
*
Mailing Address
Mailing Address Line 2
City
State / Province
Postal / Zip Code
Street Address (if different from above)
Please check one of the following.
*
This is a new Library card application
My child has a Library account and card and this is our current information.
My child has a Library account but needs a replacement card. This is our current information.
Children's Room Computer Access (Library computers at Greensburg Decatur County Public Library) Parent must check one when registering a child under 13.
*
Child under 13 may use the Greensburg Library Internet.
Child under 13 may use the Greensburg Library Internet with a supervising parent/guardian.
Child under 13 may not use the Greensburg Library Internet
By checking the box below I am confirming the understanding that I am responsible for the materials that my child may check out on this card account.
*
Yes, I understand
Submit
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