Youth Application for Library Card

Youth Application for Library Card

Eagle Mountain Public Library
Child's Information
Name*

First NameLast Name
Date of Birth (MUST be age 5 or older for library card)*

MonthDayYear
Date
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:*
Please enter a valid phone number.
Parent/Legal Guardian Information
Name:*

First NameLast Name
Relationship to Child:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Please enter a valid phone number.
Email*
example@example.com
Would you like to opt in to receive text message notifications of overdue items and holds?*

YesNo
Drivers License #*
State*
Expiration Date*

MonthDayYear
Please enter your date of birth
I give my child permission to have a library card. I will be responsible for all items borrowed and charges incurred on this card. I understand that my child will have unrestricted access to all resources, both in print and electronic in the library. Any restriction of my child's use of library resources rests with me. No one but my child may use this card.
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 5-12 MUST have a parent/guardian accompany them during ANY computer/internet usage. Children over 13 may access internet/computer usage with parent/guardian consent and signature.

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 of my child to use the computer/internet and agree to comply with all rules and regulations. Privileges may be reoved 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
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:

Youth Application for Library Card

Child's Information

Parent/Legal Guardian Information