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    Library Card

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    Blanca Fimbres
    This document is a library card registration form for the Camarena Memorial Library. It requests the applicant's name, home address, phone numbers, date of birth, driver's license or ID number, email address, and signature. For minors, it also requires the parent/guardian's name, signature, and contact information. It outlines the library rules regarding payment of fees for lost or damaged materials, responsibility for items checked out, and overdue fine amounts. The purpose is to register new patrons at the library and obtain their basic contact details and agreement to the library's policies.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Library Card

    Uploaded by

    Blanca Fimbres
    65 views1 page
    This document is a library card registration form for the Camarena Memorial Library. It requests the applicant's name, home address, phone numbers, date of birth, driver's license or ID number, email address, and signature. For minors, it also requires the parent/guardian's name, signature, and contact information. It outlines the library rules regarding payment of fees for lost or damaged materials, responsibility for items checked out, and overdue fine amounts. The purpose is to register new patrons at the library and obtain their basic contact details and agreement to the library's policies.

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    This document is a library card registration form for the Camarena Memorial Library. It requests the applicant's name, home address, phone numbers, date of birth, driver's license or ID number, email address, and signature. For minors, it also requires the parent/guardian's name, signature, and contact information. It outlines the library rules regarding payment of fees for lost or damaged materials, responsibility for items checked out, and overdue fine amounts. The purpose is to register new patrons at the library and obtain their basic contact details and agreement to the library's policies.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    65 views1 page

    Library Card

    Uploaded by

    Blanca Fimbres
    This document is a library card registration form for the Camarena Memorial Library. It requests the applicant's name, home address, phone numbers, date of birth, driver's license or ID number, email address, and signature. For minors, it also requires the parent/guardian's name, signature, and contact information. It outlines the library rules regarding payment of fees for lost or damaged materials, responsibility for items checked out, and overdue fine amounts. The purpose is to register new patrons at the library and obtain their basic contact details and agreement to the library's policies.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    CAMARENA MEMORIAL LIBRARY

    Library Card Registration


    (Please bring a current utility bill and picture identification/Favor de traer un recibo de utilidad reciente e identificación con foto)

    Name __________________________________________________________________________
    (Please print) Last (Apellido) First (Nombre de Pila) Middle Name (Segundo nombre)

    Home Address __________________________________________________________________


    Domicilio Address Apt. #

    _____________________________________________________________________________________________
    City (Ciudad) State (Estado) Zip Code (Código Postal)
    Telephone (____) __________________ Cell Phone (____) __________________________
    Teléfono Day (Número de día) Celular

    Birthdate _______ /_______ / _______ Male _______ Female _______


    Mo. Day Year
    CA Driver’s License/ID No._____________________________ (if applicant is minor, please provide parent’s ID)

    E-mail address______________________________________ Add me to e-mail list Yes___ No___


    I agree to follow all library rules, to pay promptly all charges for lost and damaged materials, and to give immediate
    notice of any change of address or loss of library card. Replacement fee for lost or damaged library card is $2 for
    adults and $1 for juveniles. I understand that I am responsible for all materials checked out on this card and that I
    am the only authorized user of this card/Estoy de acuerdo en obedecer las reglas de esta biblioteca, acepto la
    responsabilidad de pagar daños justamente cargados y de notificar a la biblioteca de mi cambio de domicilio.
    Overdue fine: 7th grade and up .15 per day, per book, up to the cost of the book / Multas: 7mo. grado en adelante
    .15 por día, por libro, hasta el costo del libro.

    Signature of Applicant________________________________________________________________________
    Firma del aplicante

    As a parent/legal guardian, I agree to be responsible for my child’s materials and any fees or charges. Any
    restriction of a child’s library materials is my responsibility as the parent/legal guardian / Autorizo que a mi
    hijo(a) se le faciliten materiales de esta biblioteca y acepto responsabilidad de pagar los daños y perjuicios
    justamente cargados. Overdue fine: 6th grade and under, .05 per day, per book up to $1 / Multas: 6to. grado y
    menores, .05 por día, por libro hasta un máximo de $1.

    Parent/Legal Guardian’s Signature (For ages 0-17)__________________________________________________

    Parent/Legal Guardian’s Name (Please print)______________________________________________________

    School________________________________ Grade_________________ Age_____________

    FOR OFFICE USE ONLY:


    Barcode_____________________________________ Library Card ________________________________

    Staff Initials _________________________________ Date ___________________________

    Rev. 4/18

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