Application/Renewal Form
Library cards must be renewed every two years to keep your information up to date. If you need further assistance, email tr.help@jclc.org or call 205-655-2022.
Is this application a request to renew an existing library card?
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Yes
No
If you are renewing your card, do you need a new card?
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Yes
No
Card Holder's Birthday
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-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Please create a four digit PIN number.
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Please remember this number because you will need it to check out and reserve items online.
Upload a current government issued photo ID with your name on it.
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Browse Files
Drag and drop files here
Choose a file
Cancel
of
Does the ID that was uploaded have the correct address? Is the ID current/not expired?
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Please Select
Yes
No
Upload current utility bill or any postmarked piece of mail with name and current address.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Would you like to add cards for your minor children?
*
Yes
No
How many children would you like to add?
Please Select
1
2
3
4
5
Child 1
First Name
Last Name
Child 1 Date of Birth
-
Month
-
Day
Year
Date
Child 2
First Name
Last Name
Child 2 Date of Birth
-
Month
-
Day
Year
Date
Child 3
First Name
Last Name
Child 3 Date of Birth
-
Month
-
Day
Year
Date
Child 4
First Name
Last Name
Child 4 Date of Birth
-
Month
-
Day
Year
Date
Child 5
First Name
Last Name
Child 5 Date of Birth
-
Month
-
Day
Year
Date
Would you like to pick up your card at the library or have it mailed to you? After 30 days the card will be mailed to you if not picked up.
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Pick up
Mail
Would you like to sign up for our newsletter? We will use the email provided above.
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Yes
No
Terms & Condtions Agreement
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By submitting this form, you agree to the following: The name, address, and all other information provided on this application are true and correct. I confirm that I am at least 18 years old. I agree - To follow all rules and regulations regarding use of my library card. To pay all fines, costs, or fees assessed by the cooperative for overdue, lost, or damaged materials. That I am responsible for all materials checked out with my library card and the cards of any minors associated with my account, with or without my consent, and for all other uses of the card. I understand that - My library card allows me to borrow materials, access website services, and use library Internet computers, software stations, and other library card-based services that may be made available. Failure to follow rules and regulations regarding use of my library card may result in suspension of library privileges.
Signature
*
Submit
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