Juvenile Registration Form

Union County Public Library District JUVENILE REGISTRATION

Please fill out and submit online

Patron agrees to all Library Polices upon activation of the library card
Name of child age 5 to 17 *

Last Name First Name
Birth Date

Month Day Year
Gender
Address *

Street Address

Street Address Line 2

City State

Postal / Zip Code
Phone Number *
Name of Adult Library Card Holder *

Last Name First Name
LIBRARY CARD NUMBER (Parent or Guardian) must be entered before submission is approved. For help call the library at 270-389-1696 *
E-mail of parent or, (legal guardian must be approved by the Director)
example@example.com
Library Card Policy

Click on link above to view policies
I have read the policy listed above and agree to all the Library Policies *
Signature: I understand by signing this form also gives my child permission to use computers and access the internet

Clear
Suggestions if any for further improvement:
Type a question
Select Yes if you will pick your card up at the library and no if you want it mailed *
Back to home page
Employees Fill Out Below This Line
Responsible Party Patron Card #
Juvenile Patron Card #
Juvenile Patron Card Pin #
Issue Date

Month Day Year
Date
Initial of staff completing form
Date Card Mailed or Picked-Up

Month Day Year
Date
Rate Us/prepared/updated by SM 11/10/21
Should be Empty: