Library Card Application
For Westport Students
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Parent's Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Primary Phone Number
*
Secondary Phone Number
E-mail
*
School Name
*
Please Select
Distance Learner
Coleytown Elementary
Greens Farms Elementary
Kings Highway Elementary
Long Lots Elementary
Saugatuck Elementary
Coleytown Middle School
Bedford Middle School
Staples High School
Grade
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Teacher
*
Enter Teacher's name or Staples Connections Advisor
Parent Signature
*
If you are a distance learner, your library card will be available for pickup at the Library two business days after submitting this form. All other cards will be delivered to your school via the school courier once a week.
Submit
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