Library Card Registration Form
Thank you for your interest in receiving a temporary library card from the Willimantic Public Library. This card will give you access to the online resource available through our website until June 1, 2020. The temporary card can be turned into a permanent card if you come into the library after we reopen.

To receive your temporary card number and pin, please provide the following information. We will not be able to issue a card if any information is missing. Please fill out a form for each person in your household interested in a library card.

At this time we are only able to provide cards to residents of Windham/Willimantic, CT. People from other communities should check with their local library to see if they have set up similar options.
Full Name (First, Middle Initial, Last) *
Your answer
Date of Birth (M/DD/YYYY) *
Your answer
Street Address *
Your answer
Street Address 2
Your answer
City/Town *
Your answer
Phone Number (xxx-xxx-xxxx) *
Your answer
Email Address *
Your answer
If this card is for a minor (under the age of 18), please provide the full name of the parent / legal guardian.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Bibliomation. Report Abuse