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 Preschool in New Canaan

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: