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    fillable_librarycard_app_2021_2_

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    fillable_librarycard_app_2021_2_

    Uploaded by

    xvgqkp4ksw
    4 views2 pages

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    4 views2 pages

    fillable_librarycard_app_2021_2_

    Uploaded by

    xvgqkp4ksw

    Copyright:

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

    Individual responsible for fines and fees must complete this form. Please print in blue
    or black ink.

    If you are unable to complete our online registration process,


    please complete the form on the following pages and mail or
    email it back to us.

    Mailing instructions
    Please send a copy of a valid form of photo ID along with your
    application and send to:

    Houston Public Library


    System Circulation Department (Library Card)
    500 McKinney
    Houston, TX 77002
    LIBRARY CARD registration
    Individual responsible for fines and fees must complete this form. Please print in blue
    or black ink.

    Name______________________________________________________ Birthdate_______________
    First Name Middle Last Jr./Sr./III MM/DD/YYYY

    Mailing Address____________________________________________________________________
    Street Address/Apt # City State Zip

    Physical Address____________________________________________________________________
    Street Address/Apt # City State Zip

    Primary Phone____________________________ Alternate Phone_____________________________

    Email Address_____________________________ Alternate Email_____________________________


    (for notices and Library information)

    FOR YOUTH BORROWERS UNDER 18 YEARS OLD:


    Youth Verification:
    o school, government oR social services agency ID o birth certificate o immunization record o IN PERSON

    Parent/guardian information:

    Parent 1 Name______________________________________________ Birthdate_______________


    First Name Middle Last Jr./Sr./III MM/DD/YYYY

    Mailing Address____________________________________________________________________
    Street Address/Apt # City State Zip

    Parent 2 Name______________________________________________ Birthdate_______________


    First Name Middle Last Jr./Sr./III MM/DD/YYYY

    Mailing Address____________________________________________________________________
    Street Address/Apt # City State Zip

    Laptop Permission granted: o yes o no


    Signature below confirms responsibility for this youth card, including fines and fees incurred, child’s selection of
    materials and use of electronic resources and the Internet.

    Borrower Agreement:
    I accept responsibility for the use of this card, including all items borrowed on it and fines/fees incurred.
    I understand that any fines/fees incurred are payable at the time they accrue and that delinquent
    accounts are subject to collection activity and may be credit reported. I agree to inform the Library
    immediately of any change to personal contact information or if the card is lost or stolen.

    Adult signature responsible for library card Date

    Borrower Information Verification:


    Photo ID: o TDL o TID o Other: ____________________________________________________

    Address Verification:
    o TDL o TID o Other: _____________________________________________________________

    Would you like an application for a Voter’s Registration Card? o Yes o No


    For Library Use Only

    Barcode Patron Type Initials


    __ __ __ __ __ __ __ __ __ __ __ __ __ __

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