Sterling Heights Public Library
Library Card Application Form

We will be happy to issue your library card to you upon completion of this online registration form. The following conditions apply:

	You are currently a resident of Sterling Heights, Michigan, and you are applying for a library card for the first time.
	Your application may take up to two business days to process.
	You have 30 days from the date to pick up your card.
	You will pick up your card at the library's circulation counter on the first floor.
	Tell the staff member that you registered on the web and be prepared to show a driver's license or state identification card with your current address. If you do not have either one, be prepared to show two other pieces of identification with your current address on them. Applicants under 18 must be accompanied by a parent or legal guardian to sign their application in the library to receive a library card.
	If you have any questions, please call (586) 446-2665.

________________________________________________________________________

Name

Address

Apt. #

City

State

Zip

Gender

Telephone Number

Birthdate (mm/dd/yyyy)

Driver's License Number (Parent's or guardian's
for children under 18)

4-Digit PIN for automated renewal service

E-mail address for automated renewal service

Terms and conditions

Please check to indicate you have read the following: (You will sign this part when you pick up  your card.)I hearby apply for a borrower's card and agree to abide by the rules and regulations of the library, to take care of all materials I borrow, to pay all fines or damages charged to me, and to give prompt notice of a lost card or change of address.

Signature_______________________________________________

PARENTAL PERMISSION FOR MINOR CHILD (Under 18)[Under Section 3 of the Michigan Privacy Act, MLC 397-601 et. seq., a library may not release a minor child's library records unless the parent or legal guardian of the minor child completes and signs this form.]I hereby declare that:(1) I am the mother/father/legal guardian (circle one) of the minor child applying for this library card; and(2) I accept full responsibility for return of library materials checked out by the above-named child, as well as liability for payment for the child's overdue fines and damaged or lost materials; and I am responsible for any restriction of materials; and(3) I give consent for the release of this child's library records to:

Print responsible person(s) name(s):

_____________________________________________________________________

Parent/Guardian's Signature:_______________________________

Parent/Guardian's Birthdate:_______________________________

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Sterling Heights Public Library Library Card Application Form

Sterling Heights Public Library
Library Card Application Form