Student Library Card Application – Prescott Public Library

School Name *

Teacher's Last Name *

Student's Name *

First

Middle

Last

Parent/Guardian Name *

First

Middle

Last

Parent/Guardian ID # *

Driver’s license #, State ID#, Passport #

Student's Birth Date *//

Email *

Phone *

Please choose a four-digit PIN *

Street Address *

City *

State *

Zipcode *

Alternate Address

Street Address

City

State

Zipcode

Yavapai Library Network Agreement

I agree to comply with all Library rules and regulations; to be responsible for materials borrowed from any Yavapai Library Network library with this card and for fees and fines incurred, including charges for lost and damaged Library materials; to give immediate notice of changes of address and loss of my Library card.

Whenever necessary, the Library uses the services of a collection agency to retrieve overdue materials. In the event of loss or damage to Library materials, or uncollected late fines or charges, I agree to pay all costs of collection, including but not limited to reasonable attorney’s fees.

I understand that my card will be accepted at all Yavapai Library Network libraries and my patron information will be accessible to staff at those libraries. *