Clark Memorial Library – Library Card Application
Name: ________________________________________________________________________________________________________________________
Parent’s Name (if younger than 13): ______________________________________________________________________________________________
Bethany Street Address: ________________________________________________________________________________________________________
Telephone: _____________________________________________ Email: _________________________________________________________________
We will notify you when books ordered from other libraries in our consortium are ready for pickup.
Would you prefer a telephone call or email message: ___ Telephone ___ Email
Signature:____________________________________________________________________________________________
Parent’s Signature (if younger than 13): __________________________________________________________________
By signing this application, I agree to follow the guidelines of Clark Memorial Library. This card remains the property of Clark Memorial Library and is subject to the policies and agreements of the Library, the LION Consortium, and borrowIT CT. This allows me to use any library in the State of Connecticut. I will notify the library if I move to a new address, or if my card is lost or stolen.
Staff Use Only Check as completed:
Card Number: __________________________________________________________ Test Library Card: ______
Initials of Library card maker: ________