PLEASE READ BEFORE SUBMITTING

• You need not apply if you lost your library card. (There is a $.50 fee to replace a lost card.)
• This form will register you as a borrower of material from Wadsworth Public Library.
• Applications will be processed within three working days, and your card will be available at the Wadsworth Public Library customer service desk.
• If you are 18 years of age or older you will be asked to present one I.D. with your current address when you pick up your card. (driver's license, checkbook, employment identification, school identification, or envelope or postcard with a recent postmark received at the address given, or utility bill)
• If you are under the age of 18 you must have your parent/guardian complete the bottom portion of this form and have them present when you pickup your card.

As a library card holder, I will:

• Observe the rules of the Library.
• Be financially responsible for all charges on any late, damaged, lost, or stolen materials borrowed on this card.
• Report the loss or theft of this card immediately to avoid unauthorized use.
• Update my name, address, and phone number whenever necessary.

For a parent, legal guardian, or person serving in loco parentis of the child under 18 who is applying for this card:

• I assume financial responsibility for materials borrowed by my child on this card.
• I understand that this card enables my child, under age 18, to borrow any item from the library collection, including books, videos, and other audio-visual materials.
• I realize that the responsibility of guiding the child in selection and use of library materials belongs with me and is not the responsibility of the Library.

Card holder information:

Field names in red are required.

Birthdate:	(mm-dd-yy) Under 18 required
Social Security #:	(optional)
First Name:
Middle Initial:
Last Name:
Mailing Address:
Apt.#:
City:
County:
Zip+4:	-
E-mail Address:
Home Phone:	(include area code)
Work Phone:	(include area code)
For a parent or legal guardian: (skip this section if over 18)
First name:
Middle Initial:
Last Name:
Mailing address:
Apt.#:
City:
County:
Zip+4:	-
Home Phone:	(include area code)
Work Phone:	(include area code)
Under Ohio law, your library records are confidential. However, you may grant access to other persons (in addition to those family members already listed) by listing their names in the fields below:
Person 1:
Person 2:
I accept (You must check this box and then click the "submit" button below in order for your library card to be issued.)