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Juvenile Library Card Registration Form Hartland Public Library
For children under the age of 16
Last Name *
First Name *
Middle Name
Date of Birth *
Mailing Address (Street, City, State, Zip Code) *
Street Address (physical address, if different than mailing address)
Hartland Resident? *
Primary Phone Number *
Name of parent/guardian or caregiver responsible for account *
Address of parent/guardian or caregiver (if different than above)
Phone number of parent/guardian or caregiver (if different than above)
E-mail Address (of parent/guardian or caretaker)
Would you like to receive our monthly library newsletter by email? *
Would you like to receive overdue notices by email and/or text? (You may choose both.) *
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) :
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.
Thank you for filling out this form. Please indicate if you would like to : *
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