Public Services – 314F
ST. JOSEPH PUBLIC LIBRARY CARD APPLICATION
Minors (Birth to 17 years old)
Name of Parent or Legal Guardian:__________________________________________________
Parent/Guardian Address: ________________________________________________________
(STREET, INCLUDE APARTMENT if applicable)
 _________________________________________________________
(CITY, STATE & ZIP)
Parent/Guardian Email Address for library notices:_____________________________________
Parent/Guardian Phone #:________________________________________
How would you like to be notified for reserved items and library notifications for your minor?
Email ______     Phone _______    Text _______
Name(s) of others authorized to use account:_________________________________________
Place Holds ______  Pick Up Holds _______    Checkout Items ______ View Borrowing History ______
X____________________________________________________________________________
Parent/Guardian Signature*
*By signing, the parent/guardian is accepting responsibility for the items checked out by the minor(s).
Name:________________________________________________________________________
         (FIRST)       (MIDDLE)         (LAST)
Date of Birth:_________________
Name:________________________________________________________________________
         (FIRST)       (MIDDLE)         (LAST)
Date of Birth:_________________
Name:________________________________________________________________________
         (FIRST)       (MIDDLE)         (LAST)
Date of Birth:_________________