First Name: * Middle Name: * Last Name: * Birth Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Parent / Guardian First Name: * Parent / Guardian Last Name: * Mailing Address: * City: * Province - Nova Scotia Only * Postal Code: * Telephone number where you prefer to be contacted (10 digits required): * Another Telephone Number, if desired: Email Address: NOTE: by providing an e-mail address, you are granting permission for your personal library information to be communicated to this address. (Example: notices about loaned material) Municipal area of residence, please choose one: * - Select -Annapolis CountyKings CountyDistrict of West HantsTown of Annapolis RoyalTown of BerwickTown of KentvilleTown of MiddletonTown of WindsorTown of WolfvilleOther If you are a seasonal resident, please provide your other mailing address (for mail out notices, etc.): Civic/Mailing Address: City: Province: Postal Code: The location where you would prefer to pick up material, please choose one: * - Select -Annapolis RoyalBerwickBridgetownHantsportKentvilleKingstonLawrencetownMiddletonPort WilliamsWindsorWolfville I, as the parent/guardian (enter name below), * understand that I am responsible for all library materials that my child reads or views. I agree to take responsibility for the materials borrowed on this card and to abide by the rules and regulations of the Regional Library. Review our Privacy Policy. Submit
