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Juvenile Library Card Registration Form Hartland Public Library
For children under the age of 16
* Required
Last Name
*
Your answer
First Name
*
Your answer
Middle Name
Your answer
Date of Birth
*
Your answer
Mailing Address (Street, City, State, Zip Code)
*
Your answer
Street Address (physical address, if different than mailing address)
Your answer
Hartland Resident?
*
Yes
No
Primary Phone Number
*
Your answer
Name of parent/guardian or caregiver responsible for account
*
Your answer
Address of parent/guardian or caregiver (if different than above)
Your answer
Phone number of parent/guardian or caregiver (if different than above)
Your answer
E-mail Address (of parent/guardian or caretaker)
Your answer
Would you like to receive our monthly library newsletter by email?
*
Yes
No
Would you like to receive overdue notices by email and/or text? (You may choose both.)
*
Yes, email
Yes, text
No
If yes to receive overdue notices by text, please select your cellular provider (if your provider is not listed, we cannot provide text notices at this time) :
Choose
Altel
AT&T
Consumer Cellular
Google
MetroPCS
Sprint
Straight Talk
T Mobile
TracFone (prepaid)
US Cellular
Verizon
Virgin Mobile
Xfinity
Please check to indicate that you have read and agree to the following:
1. I agree to abide by the rules and policies of the library, and understand that Internet access and materials at this library for all users, including youth, are not filtered, censored, nor restricted.
2. I am responsible for all items borrowed from the Hartland Public Library for myself or my child.
3. If obtaining a card for a child, I have legal rights to do so.
*
Yes, I have read the above policies and rules. Checking this box will serve as my signature.
Required
Thank you for filling out this form. Please indicate if you would like to :
*
Pick up your card at library
Have your card mailed to you
Submit
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