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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 # ________________________________________

 

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