SCL: Library Card Application: 17 and under

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SCL: Library Card Application

Library Card Application: 17 and under

Please fill out this form completely. You may also fill out the form, print and bring the printout to your local library branch to receive a library card. Please note: library cards must be updated annually to ensure the accuracy of your account.

17 and Under Information

Last Name:
First Name:
Middle Name:
Address:
City: State:
Zip Code: County:
Birth date:

Parent or Legal Guardian Information

Last Name:
First Name:
Middle Name:
Address:
City: State:
Zip Code: County:
E-Mail Address:
Would you like to receive the library calendar by E-Mail?   Yes
Birth date (mm/dd/yyyy) :
Phone Number:

How did you you hear about the library?

I would like to pick up my new library card at the following library:
Please choose the size of your new library card.

To activate your new library card you must show identification. The following forms of identification may be used: California ID, California driver's license, or student ID along with proof of your mailing address. The following forms of address verification may be used: current utility bill (postmarked within 30 days), lease, rental agreement or rent receipt showing address (dated within 30 days), current post office box receipt, or mail that has been sent to you at your current address ( postmarked within 30 days).

PLEASE READ:

I HAVE GIVEN PERMISSION FOR THE MINOR LISTED ON THIS APPLICATION TO RECEIVE A LIBRARY PRIVILEGES.

I AGREE TO BE RESPONSIBLE FOR ALL MATERIALS BORROWED BY THE MINOR WITH THIS CARD AND FOR ALL FINES INCURRED, INCLUDING CHARGES FOR LATE, LOST, AND DAMAGED MATERIALS.

I UNDERSTAND THAT I AM TAKING RESPONSIBILITY TO ENSURE THAT THE MINOR WILL FOLLOW ALL LIBRARY RULES OF BEHAVIOR, AND THAT IF HE OR SHE CHOOSES NOT TO COMPLY WITH THESE RULES, HIS/HER LIBRARY PRIVILEGES MAY BE SUSPENDED OR REVOKED.

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Revised: October 19, 2010

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