Adult Library Card Registration Form
For Ages 16 and Over
Hartland Public Library
Last Name *
Your answer
First Name *
Your answer
Middle Name
Your answer
Mailing Address (Street, City, State, Zip Code) *
Your answer
Street Address (if different than mailing address)
Your answer
Hartland Resident? *
Phone Number *
Your answer
Cell Phone Number
Your answer
E-mail Address
Your answer
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) :
Would you like to receive our monthly library newsletter by email? *
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 : *
Submit
Never submit passwords through Google Forms.
This form was created inside of Hartland Public Library. Report Abuse - Terms of Service