OC Public Libraries
Electronic Library Card Application

Request will expire on : 09 - 18 - 2008

Library Card Applicant

* Indicates a required field.

Name:    Last: *    First: *    Middle:

Home Phone:     PIN: *    (Choose a password, 4-10 Letters/Numbers)

Birth Date ( mm / dd / yyyy ): *        Gender*: Male        Female

Please select the branch where you would like to pick up your new library card: *

 

 

Residence

Please fill in your current address information.
If the Mailing Address is a PO Box then an Alternate Address is required.
Email is required when notification is set to email.

Mailing Address - Street: *    Apartment Number:

City: *    State: *    Zip Code: *   

Email:        I prefer notification by: Email    Phone

Work Phone:        Other Phone:
Alternate Address - Street:     Apartment Number:

City:     State:     Zip Code:

 

 

Identification

If the applicant is less than 18 years old, the Parent’s/Guardian’s name, date of birth and ID number are required fields; ID is required for all applicants 18 years or older.*

Parent / Guardian:    Last:     First:     Middle:

Parent / Guardian - Birth Date ( mm / dd / yyyy ):

California Drivers License or ID Number: *

Preferred Language:

 

* Indicates a required field.

You must bring photo ID and proof of address to obtain the card requested via this form.

Your library card is held at the branch for 30 days after processing before being deleted from the system.

Acceptance Policy

I accept financial responsibility for all materials borrowed with this card. Costs may include overdue fines, replacement costs for lost/damaged materials, processing fees for each item lost and additional fees if referral to collection services is required. I promise to notify the library promptly if my address changes or my card is lost or stolen, and to comply with all library rules and policies.

Check box to accept policy: