Library Card Application Form

Library Card Application Form

Ages 16+
After submitting this form online, you must visit the library with ID and proof of address in order to obtain a card.
Preferred Name*

First NameMiddle Name or InitialLast Name
Birthdate*

MonthDayYear
Date
Driver's License Number & State
Applicants under 18 can use a parent or guardian's ID number
Name on Identification (if different from preferred name)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing address (if different from home address)
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email
example@example.com
Notification preference *
Mobile Carrier
Required if you selected text notifications
Would you like to receive periodic emails about library news, special events and activities?

YesNo

I agree to observe all rules established by the library and will be responsible for all materials borrowed on my card. I also agree to pay charges imposed for loss of or damage to library materials. I will notify the library if my card is lost or if I change my name or address. I verify that the information on this form is correct.
Signature*

Clear
Should be Empty: