Albion Public Library Patron Registration Form.  After you complete this form, please take it to the Circulation Desk.  The information will be confidential.

 

Date: ____________________

 

Name (include middle initial): ______________________________________________________________________________________________

Address: ______________________________________________________City: _______________________Zip: _________________________

 

Alternate Address: ______________________________________________________________________________________________________

                            (College/property owners)

 

E-Mail Address (fill in to receive notifications by email): ______________________________________________________________

 

Phone Number (home): __________________________ Phone Number (work): ____________________

 

ID Number (Michigan Driver’s License, Michigan Identification Card, etc.): ______________________________

 

Birth date (if under 18): __________________________

 

Library Card Agreement:  I agree to be responsible for library materials and for fines and lost items.

Signature: ____________________________________________________________

 Parents of children under 18:  you must sign on the back.

 

Internet Agreement

To use the local dial-in modem lines or to use the library’s web-based card catalog and reference materials, every user must agree to the following:

1.     To respect the privacy of others (you may not use other’s passwords or represent yourself as someone else)

2.     To respect copyright and licenses to programs and data

3.     To respect the integrity of computing systems (you may not alter software in our network)

4.     To respect the rights of others to network access (no games)

5.     To respect the not-for profit aspects of the network

6.     I understand that I am limited to one hour on the library’s public Internet computers and two hours on the local dial-in modem lines.

 

Signature: _____________________________________________________

 

STAFF ONLY: Amount received: ______ID: __________Password____________Month/year expiration_______

 

 

 

 

 

 

 

 

Parent/Guardian (if applicant is under 18)

 

Please print your name: ________________________________________________________________________________________               

Address and phone if different from children: _______________________________________________________________________

Driver’s License Number or ID with address: _______________________________________________________________________

 

Agreement:

I agree to be responsible for the library materials checked out on the card of the minor child named above.  I will pay for fines and lost materials.   _______________(Initials)

I give consent for this child’s library records to be released to me if items are overdue.  ______________(Initials)

I give consent for my child to use the Library’s card catalog and many of the reference materials that will give him/her access to the Internet.  I realize that the library staff does not limit access to information on the Internet and that it is my responsibility to agree with my children what kinds of information they are allowed to view and use. ________________(Initials)

 

Signature: _____________________________________________                              Relationship to child: ________________________

 

 

 

Staff Use:

Patron Type:    Regular____ Under 18w/I____ under 18w/oI_____ Jackson_____ Out-of-Area____

              Telecourse____ In-library ____ Temp___ Business/Org_____ Paid_____(amount)

 

PIN: __________                                                             Card Expires: ___________                New_____ Renewal_____         
                               

Area:                City _____ ST _____ AT _____ Jackson _____ Paid _____ College _____ Property Owner _____

                                                                                                        

Staff Initials: ___________