Jean M. Thomsen Memorial Library - Adult Card Application
Please complete the following form to apply for a library card for use at the Jean M. Thomsen Memorial Library and in the Wisconsin Valley Library System (WVLS). Email ststaff1@outlook.com with any questions you may have regarding your application. You will be contacted with your library card number upon successful completion of this application. More information may be required to confirm proof of residency.
Email address *
Name (Last, first, middle initial): *
Date of Application *
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Birth date (Month, day, year): *
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Resident of (please indicate city, village, or township): *
County of residence: *
Street address (Street, apartment, etc.) *
Address continued (City, State, Zip Code) *
Telephone Number (Please indicate home, work, or cell): *
Email:
Driver's License Number and State of License:
Please indicate whether you'd prefer notifications via email, phone, or text. (Text notifications will require an additional opt-in after card approval). *
Please type your name in agreement with the following statement. "I apply for the right to use the Library. I agree to comply with all Library rules and regulations and give immediate notice of changes to the above information." *
Please type your name in agreement with the following statement. "Adult Internet Access Consent: I understand that any actions deemed inappropriate by the library may result in the suspension or termination of internet access privileges, depending on the severity of the offense. Legal action may take place in case of breach of file security or where action violates local, state, or federal rules, laws, or regulations." *
Please type your name in agreement with the following statement. "Photo Release Form: The Jean M. Thomsen Memorial Library has my permission to use my or my child's photograph publicly to promote the library. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to the library by reason of such use."
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