Public Library Membership

Public Library Membership

Junior Membership Application
PLEASE COMPLETE THIS FORM TO PROCESS A JUNIOR MEMBERSHIP

Parents/Guardians, Please read the Public Library Service Terms and Conditions before submitting this form
Junior Member Details
Surname*
First Names*
Date of Birth*

DayMonthYear
Date
Age
School Attending*
Parent/Guardian Details
Surname*
First Names*
Home Address*

Street/Area

District of Residence

CityState / Province

Postal / Zip Code
Work Address

Street/Area

District of Employment

CityState / Province

Postal / Zip Code
Home Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Home Email
example@example.com
Work Email
example@example.com
Should be Empty:

Junior Member Details