Library Registration Form

MARYVILLE COMMUNITY LIBRARY REGISTRATION FORM

Please Clearly Print All Information

D.O.B. (mm/dd/yyyy):____/___/______         Driver’s License #                                                    

Name:_______________________________________________________________________

    Last                                                 First                                                     M.I.

Address:_____________________________________________________________________

                        Street                                       City                             State                    Zip

Phone:__________________        _________ Cell Phone:______________________________

Email:__________________                   _________Work Phone:___                 ____________

Parent or Guardian Name:_______________________________________________________

 (If applicant is under 18)

Address:_______________________________________Phone:________________________

 (If different from above)

I prefer to be contacted by:                            e-mail                                      phone

By signing below, I assume full responsibility for my Library Card and will pay all fines for overdue materials, all fees assessed for damaged or lost materials, and all charges incurred if the Library is required to submit my account to a collection agency. I will notify the Library immediately if my card is lost or stolen. I understand that I am responsible for my child’s use of all library materials, including the Internet.

Signature:_____________________________________________________

Date:__________________

______________________________________________________________________________Office/Staff Use

 Card Number:________________________________ Staff Initials:____________________

Please Note: Proof of residency within the Maryville Community Library District Boundaries, is required of all applicants. Parents must provide proper identification for all minor children. Suitable forms of ID include: Driver’s License, Voter Registration card, or recent utility bill (if other form not available).