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Child's Online Library Card Application

2. Instructions (PLEASE READ)
   This application is designed to collect the information from parents/guardians needed by Placer County Library Staff to create and issue a library card for children to utilize library resources (physical and online materials). By submitting this application, the responsible party agrees to understanding that you are responsible for all materials borrowed on this card. You will receive your child's library card number and Personal Identification Number (PIN) via e-mail from library staff. The physical card will be mailed to the address you provide in the application. If you do not wish to use physical library materials or do not wish to provide all of the following information you can instead apply for an e-card. Please direct any questions to: library@placer.ca.gov

   This application is designed to collect the information from parents/guardians needed by Placer County Library Staff to create and issue a library card for children to utilize library resources (physical and online materials). By submitting this application, the responsible party agrees to understanding that you are responsible for all materials borrowed on this card. You will receive your child's library card number and Personal Identification Number (PIN) via e-mail from library staff. The physical card will be mailed to the address you provide in the application. If you do not wish to use physical library materials or do not wish to provide all of the following information you can instead apply for an e-card. Please direct any questions to: [email protected]

4. If you do not wish to provide the following information you can apply for an e-card that will allow you access to online materials, but not physical library materials.
   E-Card Application

6. Child's First Name*

7. Child's Last Name*

9. Responsible Party First Name (Parent/Guardian)*

10. Responsible Party Last Name (Parent/Guardian)*

11. Responsible Party Driver's License/ID Number*

13. Child's Date of Birth*

    MM/DD/YYYY

15. Preferred Method of Receiving Library Notifications
    -- Select One --E-MailText Messaging/SMS

16. E-mail Address*

17. Confirm E-mail Address*

19. Phone Number

20. Mobile Carrier

    This is required if you choose to receive text notifications (Example: Verizon, AT&T, Sprint, T-Mobile, etc...)

22. Preferred Physical Library Location*
    -- Select One --ApplegateAuburnColfaxForesthillGranite BayKings BeachPenrynRocklinTahoe City

23. Name of School*

    If child is a student please let us know what school they attend.

25. Mailing Address*

27. City*

28. State*

29. Zip Code*

31. By signing and submitting this form I understand that I am responsible for all materials borrowed on this card.

33. Parent/Guardian Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Responsible Party (Parent/Guardian) Electronic Signature*

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field