High School Student Library Card Application (This application is for High School students only, not for adults.)
Please fill out the form correctly and completely.
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First Name, Middle Initial (if applicable), and Last Name: *
Complete School W-Box Mailing Address:
Be sure to include the CITY, STATE, and ZIP CODE
[Your card will be mailed to this address, so it’s important we have your correct W-Box information. (This only applies to MSMS students. If it doesn't apply to you, please enter N/A.)  *
Complete Home Mailing Address: 
Be sure to include the CITY, STATE, and ZIP CODE
[This is your permanent residence when you're not at school.] (This only applies to MSMS students. If it doesn't apply to you, please enter N/A.)   *
Complete Home Address:
Be sure to include the CITY, STATE, and ZIP CODE (Please double-check for accuracy—your card will be mailed to this address.) If you are an MSMS student, please skip this section and enter "N/A." All other students are required to answer this question.    *
Complete Mailing Address:
Include CITY, STATE, and ZIP CODE.
(Only if different from your home address. Please ensure this information is accurate—your card will be mailed here.) If you are an MSMS student, please skip this section and enter "N/A." All other students are required to answer this question.    *
Email Address:
[Please provide the email you check regularly.]
Attention Lowndes County Students: Do NOT use your school email address. *
Parent's Email Address:
(This will be used to contact your parent or guardian to obtain their consent for issuing your library card.)   *
Personal Phone Number:
(Please provide the number where you can be directly reached.)   *
Parent or Guardian Phone Number:
(This number is for record-keeping purposes only; we will not contact your parent or guardian without necessity.)   *
Birthdate:
(Please enter the date in the format: two-digit month, two-digit day, and four-digit year. For example: 01/01/1900)   *
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Acceptance of Responsibility:
Please read the following statement thoroughly and indicate whether you agree or disagree with the terms for the issuance of your Columbus-Lowndes Public Library Card.

Acceptance of Responsibility:
By signing, I acknowledge that I will be responsible for all materials borrowed on this card. I agree to immediately report any lost or stolen card, as well as any changes to my mailing or email address. I understand that I may incur charges for overdue, lost, damaged, or stolen library materials, and a replacement fee will apply for a lost, damaged, or stolen library card. I am aware that library cards must be renewed every three years. By signing this application, I accept responsibility for all materials borrowed on the card, including those checked out by others.

If you do not agree, your card will not be issued.

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Student's OR Parent's Initials and Date *
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