Madison Library Card Application – For children ages 5 to 11

Madison Library Card Application – For children ages 5 to 11
Please print neatly and fill out form completely. Application should be filled out in ink.
Name _________________________________________________________________________
Printed by Child applying for card
When I write my name on this application, I promise to take good care of the materials I
use in the library and at home, and to follow the rules of the Madison Library.
Mailing Address ________________________________________________________________
______________________________________________________________________________
Permanent Street Address ________________________________________________________
______________________________________________________________________________
Phone Number _____________________________Birth Date ___________________________
Parent or Legal Guardian Information:
Parent’s / Guardian’s Name _______________________________________________________
Mailing Address (if different from child’s) ___________________________________________
______________________________________________________________________________
Please read and sign:
Please read the Madison Library Circulation Policy on the back of this application before
signing.
I am willing to have my child borrow materials from the Madison Library, and I promise to make
good any damage or loss and to pay any fines justly charged to my child.
Parent’s / Guardian’s Signature: ____________________________________________________
Please present 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 the library card to your child.
Computer Use: If you plan to allow your child to use the public computers at the Madison
Library, 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: __________________
November 19, 2010 Madison Library Policies 52