Madison Library Card Application – For children ages 5 to 11

Madison Library Card Application – For adults and children 12 and
older
Please print neatly and fill out form completely. Application should be filled out in ink.
Name ________________________________________________________________________
Mailing Address ________________________________________________________________
______________________________________________________________________________
Permanent Street Address ________________________________________________________
______________________________________________________________________________
Seasonal Home Address __________________________________________________________
______________________________________________________________________________
Note: If you are not a Madison resident or seasonal property owner, OR an employee of the
Town, the Madison Elementary School, or a Madison business, there is a $15 annual fee for a
Madison Library card.
Email Address _________________________________________________________________
May we send reminders of books due by email? Yes No
Would you like to receive email updates of library events? Yes No
Phone Number _____________________________Birth Date (if younger than 18) ___________
Please read and sign:
Please read the Madison Library Circulation Policy on the back of this application before
signing.
I hereby agree to follow all the rules and regulations of the Madison Library. I will pay promptly
all fines charged against me for the late return of materials and for the injury or loss of materials.
I will give immediate notice of any change of address.
Signature: _____________________________________________________________________
Please present photo ID and verification of current mailing and street address with
application. Accepted forms of ID include driver’s license or non-driver’s state ID, recent utility
or tax bill mailed to your mailing address, lease or rental agreement, post office box receipt. If
you cannot present verification of mailing address, we will mail your card to you.
Computer Use: If you plan to use the public computers at the Madison Library or the library’s
wireless internet connection, please read and sign our separate Computer Use Agreement.
FOR LIBRARY USE: Card Number: _____________________________________________
ID presented: License Mail Other_____________
Computer agreement on file? Yes No
Date Card Issued: __________________
Nonresident Fee collected: Yes No
November 19, 2010 Madison Library Policies 51