New Canaan Library Card Request for Schools

What school does your child attend? *

St. Aloysius School St. Lukes New Canaan Country School New Canaan High School Saxe Middle School East Elementary School South Elementary School West Elementary School

Student Information
Child's Name *

First Name Last Name
Student's Grade *
Child's Date of Birth *

Month Day Year
Date
Child's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's Email (optional)
example@example.com

Parent/Guardian Information

Students 16 and older with a photo ID may complete this section for themselves.
Name of Parent or Guardian *

First Name Last Name
Parent's Email *
example@example.com
Phone Number *
Photo of Parent or Guardian's ID: *
By providing this information you understand that you hold the responsibility of this card and any materials your child checks out as well as associated fines incurred. *

I agree.
Should be Empty: