A PARENT OR GUARDIAN SIGNATURE IS REQUIRED FOR YOUTH UNDER 18 YEARS OF AGE.
An internet card will be assigned upon approval of the signature.
Please print child's name and address:

Name:____________________________________ Phone: _______________
Address:___________________________________________ DOB: ____________
I agree to assume responsibility for the above named child in the use of 
library internet services.
Parent/Guardian Signature:______________________________ Date: ______
BOARD APPROVED July 1, 2004