Library Card Application Form
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Message Number
Please enter a valid phone number.
Grade
if in school
Address
Street Address
Mailing Address
City
State / Province
Postal / Zip Code
What's the reason for applying to a library card? Please specify.
(student, research, borrowing a book, etc.)
Parent Name (if under 13)
First Name
Last Name
Permission to use Computer (if under 13)
Yes
No
A parent/legal guardian signing for a child's card also agrees to be responsible for monitoring materials checked out by the child named above. I and my child agree to abide by the rules and guidelines of the Laguna Public Library. I verify that the information on this form is correct. A parent/legal guardian who elects to allow huis/her child to use the library's public computer accept responsibility for the child's computer use and agrees to allow the child to use the internet.
Parent Signature (if under 13)
By signing this form, I accept financial responsibility for all materials checked out on this card with or without my consent, and for all fees incurred in the use of this card. I agree to restrict the use of this card to my personal use, and to immediately report its loss or theft to Library Staff. I certify that all information given is accurate and true to the best of my knowledge.
Signature
Would you like to receive periodic emails about library news, special events and activities
Yes
No
Continue
Continue
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