Phone (555-456-7890) *

First Name *

Last Name *

Address *

City *

State (TX) *

ZIP *

Guardian's Name *

Guardian's Email *

Grade *

Any special requirements?

Birthday (YYYY-MM-DD) *

By clicking the box below, you understand that as the Parent or Guardian of the above child, you are responsible for any materials borrowed by this child. Your child will be allowed to check out books in the library, and online, as well as have access to online databases offered by the library. *

Signature of Parent/Guardian - Please type your full name. *