1

Member Information

 *

Member Information

First and Last name

Library card number

2

Contact Information

 *

Contact Information

Email address

Confirm email

Street address

Phone numberext.

3

Notification Preference (Select all that apply)

Notification Preference (Select all that apply)

Email

Text

4

If text notification is selected, please provide cell phone carrier.

Phone Carrier

5

 For Parents/Guardians of any minor aged 17 and under. *

For Parents/Guardians of any minor aged 17 and under. *

By giving permission for my child to have this card, I (as the parent/guardian) acknowledge that the content and subject matter appropriateness of materials that my minor child accesses through the John P. Holt Brentwood Library are not monitored by Library staff and are my responsibility to monitor.

I am over the age of 18.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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