CHILD

Date(day-month-year)

Last Name First Name Initial

Address:
No. Street City

State Zip Code

Phone ()

Email

Birth Year

Have you had a previous library card in Westchester?
Yes No

Do you wish to be contacted by phone or email?
Phone Email

PARENT

I agree to be responsible for all library materials borrowed on my child's card, to pay any fine charged to my child's card for overdue, damaged, or lost materials, and to notify this library of our address changed or my child's card is lost or stolen.

PARENT

Date(day-month-year)

Last Name First Name Initial

Address:
No. Street City

State Zip Code

Phone ()

Email

Have you had a library card in Westchester?

If you would like to receive emails from us alerting you of upcoming events, please select "Yes" on the following box:
Yes No

This information will NOT be shared with others party and is solely for notification purposes.