Student Library Card Application

School Name

Teacher's Last Name

Student's First Name

Student's Middle Name

Student's Last Name

Parent/Guardian First Name

Parent/Guardian Middle Name

Parent/Guardian Last Name

Parent/Guardian ID # Driver’s license #, State ID#, Passport #

Student's Birth Date

Cursor keys can navigate dates

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.

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