First Name *

Middle Name

Last Name *

*

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Legal Last Name

Date of Birth *

Allow Authorized Access?

If you are a minor, you must list at least one parent or guardian who shares your home address. Authorized Access lets you specify up to two people that may pick up holds on your behalf. To learn more about authorized access, please see this FAQ.

It is the policy of the Canton Public Library that all library records are kept confidential and only shared with the cardholder and/or as a result of appropriate legal orders. If you wish others to have access to your account, please indicate below: I agree that the following individuals have the ability to pay fees and/or pick up held items on my account with proper identification. All other account information will remain confidential. I can change or void this list at any time by presenting identification to the library and requesting that individuals be removed or added to the list.

Parent/Guardian Name

The parent or guardian that signs this form is responsible for the use of this card and any related charges per the library’s policies and is legally responsible for all materials borrowed on this card. Library staff will not monitor the use of this card and the borrowing of materials and/or computer usage on this account. A completed application form will be available for parent/guardian to sign when you visit the library and verify your eligibility.

Parent/Guardian's *