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2. First Name*
   Type your first name here
3. Middle Initial
   Type your middle initial here.
4. Last Name*
   Type your last name here.
6. Birthdate*
   Type in your birth date here. Example: 01/04/1998
8. Street Address*
   Type your street address here. Please include apartment number if applicable.
9. City*
   Type the City you reside in.
10. Zip Code *
    Type your zip code here.
12. Phone Number*
    Type in your phone number here. Example: 123-456-7890 Your phone number can be used to notify you if we have any questions about your account.
13. Email Address
    Type your email address here. Your email address can be used to notify you when Hold items are available.
15. Age Group*

    1. 0-17
    2. 18-61
    3. 62+
16. Preferred Method of Hold Notification*

    1. Email (same day notification)
    2. Text (next day notification, cell phone only)
    3. Phone (next day notification)
    4. No hold notice

    Choose one of the above as the main way to contact you when your Hold items are available.
17. Pre-Overdue Notices (Optional)

    1. Check here for Pre-Overdue Notices

    If you would like to receive an email notice 2 days in advance of your due date, check the box above. These can only be received if you choose EMAIL as your hold notification.
19. Photo ID *
    Please provide a picture of your photo ID, with your name, face, and physical address in the image. If your physical address is not on the ID or is not your current address, please also submit Proof of Address below.
21. Proof of address (If not on photo ID)
    Please provide an image of proof of address that shows your name and current address. This can be a bank statement or utility bill.
23. ACCEPTANCE OF RESPONSIBILITY*

    Please read and click the digital signature box that you understand the following: I will be responsible for all materials checked out on this card, including materials checked out by others with or without my consent, unless I have previously reported the loss of my card. I will report a lost or stolen card, or any change of personal information (name, address, phone, email), immediately. I will comply with all library rules and policies. I understand that there will be charges for overdue, lost, damaged and stolen library materials. I understand that the library provides access to a broad range of resources and that it is my responsibility to judge for myself and for my children or minor dependents what resources are appropriate for my/our personal use.

    1. Check here that you have read and agree to the Acceptance of Responsibility agreement
25. Patron digital signature: *
    Please type full name.
27. Parent or Legal Guardian Signature for patrons ages 0-13

    1. Yes, I am the legal guardian.

    Please click the box to submit that you are the parent or legal guardian of the person completing this form.
29. Name of Parent or Legal Guardian
    Please provide your name as the parent/legal guardian.
33. FOR OUTREACH - STAFF NAME:
34. Patron Barcode Number Assigned:
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field