Application for translation
Pawtucket Public Library
13 Summer Street/ Pawtucket, Rhode Island 02860
401-725-3714 / www.pawtucketlibrary.org
Student Library Card Application - Please PRINT all the information on this form
All information provided to us will be treated as confidential.
Child's School:__________________________________________
Child’s First Name:___________________________
Child's Last Name:___________________________
Street Address:______________________________________________ Apt #____
City/Town:_______________________________ Zip Code:___________
Home Phone Number____________________
Cellphone Number:_____________________
Child’s Date of Birth: _____/____/____
Parent/Guardian Email Address:_______________________________________________________________
____ Yes, I would like to receive my child’s reserve notices and overdue reminders by email.
Parent or Guardian information for children under age 13:
Parent or Guardian name (Please Print):____________________________________
Relationship to child (mother, father, etc):______________________
I give permission for my child to receive a library card. I understand that my child will have unrestricted access to all resources in the library. Any restriction of a child’s access to library materials, electronic resources or the Internet is the responsibility of the parent or legal guardian. Media borrowing restriction forms for minors are available upon request.
I understand that failure to return library materials may result in legal action. I agree to observe all rules and policies established by the Pawtucket Public Library and all other Ocean State Libraries.
Parent or Guardian Signature:____________________________________________
Date:_____________
FOR LIBRARY STAFF USE ONLY:
Staff Initials __________ Date ____________ Old Barcode #:_____________________________________
New Barcode # ________________________________________
