Library Card Form - under 14 years of age | Annapolis Valley Regional Library

First Name: *

Middle Name: *

Preferred Name

Last Name: *

Birth Date *

Month

Day

Year

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): *

Email Address:

NOTE: by providing your email address, you are agreeing to receive notifications about your library account by email.

Municipal area of residence, please choose one: *

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: *

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.

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Library Card Form - under 14 years of age