Adult Application for Library Card

Adult Application for Library Card

Eagle Mountain Public Library
Name*

First NameLast Name
Home Address*

Street Address

CityState / Province

Postal / Zip Code
Is your Mailing Address the same as your Home Address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Please enter a valid phone number.
Email*
example@example.com
Drivers License #*
State*
Date of Birth*

MonthDayYear
Please enter your date of birth
Would you like to opt in to receive text message notifications of overdue items and holds?*

YesNo
I will be responsible for all items borrowed and any charges incurred on this card. I agree to abide by the policies set forth by the Eagle Mountain Library and borrow and return items as required.
Signature*

Clear
Date

MonthDayYear
Please enter today's date
Internet Access

The Eagle Mountain Library does not monitor and has no control over the information accessed through the Internet, and cannot be held responsible for its content. As with other library materials, parent and legal guardians who are concerned about their children's use of the Internet should provide guidance to their own children and should monitor their use of this resource. All children 8-12 MUST have a parent/guardian accompany them during ANY Internet usage.

Use of the Internet is a privilege, NOT a right, and a violation of the library Internet use policy and rules will result in a suspension, and eventually, cancellation of this privilege. Your signature on the Internet use policy and rules will result in a suspension, and eventually, cancellation of this privilege. Your signature on the Internet use policy registration is legally binding and shows you (the patron) who signed it has read the terms and conditions of the policy and understands its significance.

I apply for the privilege to use the Internet and agree to comply with all rules and regulations. Privileges may be revoked at any time.
Signature*

Clear
Date

MonthDayYear
Please enter today's date
Would you like to receive your library card in the mail?*
Please upload the following attachments:
- Copy of Valid Driver's License, Military ID, State ID, etc. *please note, we are unable to accept selfie photos for photo identification*
- Verification of address - copy of utility bill, mail delivered with YOUR name to address, bank statement, etc.
If on mobile, clicking on "Browse Files" will also allow you to use your phone camera to take a picture of an ID.
Valid Identification*

Cancelof
Verification of Address*

Cancelof
STAFF USE ONLY
Staff Initials

Clear
Application Status
Reason for Denial
Today's Date

MonthDayYear
Date
Barcode Number
Should be Empty: