Student Library Card Application
Please fill out form CORRECTLY & PROPERLY.
First Name, Middle Initial, & Last Name *
*COMPLETE* School W-Box Mailing Address... ***Please include CITY, STATE & ZIPCODE*** [Your card will mailed to you. We need a w-box to mail your card to you.] (ONLY APPLIES TO MSMS STUDENTS.) If this doesn't apply to you, type N/A. *
*COMPLETE* Home Mailing Address... ***Please include CITY, STATE & ZIPCODE*** [the place you reside when you are not at school] (ONLY APPLIES TO MSMS STUDENTS.) If this doesn't apply to you, type N/A. *
*COMPLETE* Home Address... ***Please include CITY, STATE & ZIPCODE*** (PLEASE MAKE SURE THIS ADDRESS IS CORRECT, YOUR CARD WILL BE MAILED TO YOU) If this doesn't apply to you, type N/A. *
*COMPLETE* Mailing Address... ***Please include CITY, STATE & ZIPCODE*** [If address is different from your home address] (PLEASE MAKE SURE THIS ADDRESS IS CORRECT, YOUR CARD WILL BE MAILED TO YOU.) If this doesn't apply to you, type N/A. *
Email Address [The one you check regularly] (Attn: Lowndes County Students!!! Please DO NOT USE your school email.) *
Phone Number (your personal number) *
PARENT's phone number (ONLY APPLIES TO MSMS STUDENTS.) If this doesn't apply to you, type N/A *
Birthdate. [Please include two digit month, two digit day, and four digit year.](example: 01/01/1900) *
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Please read completely and select if you agree or disagree to the Acceptance of Responsibility for your Columbus-Lowndes Public Library Card. Acceptance of Responsibility: I will be responsible for all materials borrowed on this card. I will report a lost/stolen card or any change of mailing or email address immediately. I understand that there is a charge for overdue, lost, damaged, and stolen library materials, and a replacement fee is charged for lost, damaged, or stolen library card. I understand that library cards must be renewed every three years. When I sign this application I assume responsibility for anything that anyone checks out on the card. *IF YOU DO NOT AGREE, YOUR CARD WILL NOT BE ISSUED* *
Student's OR Parent's Initials and Date *
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