LIBRARY PATRON CARD APPLICATION

Name Name First Last
Phone Phone - ### - ### ####
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Date Date / MM / DD YYYY
Are you an Osage Member?
What is your Membership number?
Are you an Osage Nation Employee?
LIBRARY POLICY

I agree to be responsible for all materials charged on my library card; to report a lost library card; to observe library rules and policies; to pay all charges; and to notify the library of an address change or name change. Library staff cannot give any information about a patron’s registration and circulation record to anyone other than the patron, regardless of age or relationship to the patron.

FOR PARENT OR LEGAL GUARDIAN OF MINOR APPLICANT

I give my child permission to have a library card and I assume complete financial responsibility for all library materials borrowed by my child. I understand that my child will have unrestricted access to all resources of the library and that any restrictions to my child’s borrowing privileges and any restrictions on access to electronic resources rests on me. I understand that I cannot use my child’s library card if they are not present.

I have read, understood, and agree to the above policy.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.