Present this form with a photo ID and proof of residency at the check out desk at any Carrollton Public Library. Applications for children under 18 must be presented by parent or guardian.
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The following information is requested to aid in the
purchase of library materials.
Language preference (circle one) English Spanish Vietnamese Korean Urdu Chinese Hindi Japanese Persian Panjabi Arabic Bengali Gujarati Ethnicity/gender: (circle one) Caucasian male Caucasian female Hispanic male Hispanic female African American male African American female Native American male Native American female Asian male Asian female Other male Other female
| Please print ______________________________________ Last Name ______________________________________ First Name Middle Initial ______________________________________ Address Apartment # ______________________________________ City ______________________________________ County ______________________________________ Zip Code (________) ___________________________ Home Phone (________) ___________________________ Alternate Phone ______________________________________ Driver's License (State and Number) ______ /______ /__________ Date Of Birth ______________________________________ E-mail Address | |
| Parents/Guardians,
Please, complete for children under 18 years of age. Internet access for my child: ___ Least restricted internet access ___ Most restricted internet access ___ No internet I understand that the choice of reading and viewing materials and internet access rests with parents. ___________________________________________ Parent's printed name and signature ___________________________________________ Parent's Driver’s License |