Library Card Application

Library Card Application

Applicant must present identification with current Eagle Mountain address.
I am applying for a new library card for:*

MyselfMinor child(ren) - ages 5 to 17
To obtain a library for for your minor child- please fill out the form using your information.
A separate area further down will allow you to enter the child's name and birthdate.
Name *

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload proof of address: ( ex: Utility bill/mail/shipping label)*

Cancelof
Cell Phone Number*
Please enter a valid phone number.
Date of birth*

MonthDayYear
Date
Driver's license/State Identification #: *
Upload image of Driver's License or State Identification ID*

Cancelof
Email*
example@example.com
Would you like to receive TEXT notifications for holds and overdue notices?*
ONLY fill out the section below if you would like to get a library card for a minor child.
Otherwise, please leave blank.
Family members ages 5 to 17:
Internet Access: If applying for a library card for minor family member(s), please state whether you give permission to access library computers.

YESNO
Statement of Responsibility:

I agree to be responsible for all materials charged on my library card and promptly pay any fees; to observe library policy and rules; and to notify the library of any name, address, telephone or email changes, and/or lost library cards.

For parents/guardians: My child will observe library policy and rules, my signature authorizes my child to use/borrow library materials and access the internet (if I have so stated above). I am responsible for all materials charged to my child's library card. My child's library fees may restrict my borrowing privileges. I will not leave children under the age of 8 unattended in the library.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: