New Canaan Library Card Request for Schools

What school does your child attend?

Student Information
Child's Name

First NameLast Name
Student's Grade
Child's Date of Birth

MonthDayYear
Date
Child's Address

Street Address

Street Address Line 2

CityState / 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 NameLast Name
Parent's Email
example@example.com
Phone Number
Format: (000) 000-0000.
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.
Should be Empty: