Age 17 & Under Library Card Application

1. A Parent or legal Guardian assumes all responsibility for all materials borrowed on this card, and for payment of overdue, replacement or other charges. Library borrower and circulation records are confidential and exempt from Freedom of Information requests. All information requested below is intended to help the library serve you better. A parent or legal guardian must accompany the child when picking up the child's card. The parent or legal guardian must bring in his/her ID and proof of Norwalk residency when picking up the card.

   A Parent or legal Guardian assumes all responsibility for all materials borrowed on this card, and for payment of overdue, replacement or other charges. Library borrower and circulation records are confidential and exempt from Freedom of Information requests. All information requested below is intended to help the library serve you better. A parent or legal guardian must accompany the child when picking up the child's card. The parent or legal guardian must bring in his/her ID and proof of Norwalk residency when picking up the card.

3. First Name*

4. Last Name*

5. Street Number

6. Street Name

7. Apt #

8. City*

9. State*

10. Zip

11. Home Phone Number*

12. Cell Phone

13. Email

14. Date of Birth*

    mm/dd/yyyy

15. Sex
    -- Select One --FemaleMale

16. Social Security Number

    (optional)

17. Parent or Legal Guardian's Information

18. First Name*

19. Last Name*

20. Driver's License Number

21. State/Country

22. Exp. Date*

    mm/dd/yyyy

23. Permission Statement:
    I give my son/daughter permission to borrow library materials and understand that I am responsible for all materials borrowed on the card, and will pay all late charges and fees for damaged and lost materials. I will notify the library if my child's card is lost or stolen, and of any address change.

    I give my son/daughter permission to borrow library materials and understand that I am responsible for all materials borrowed on the card, and will pay all late charges and fees for damaged and lost materials. I will notify the library if my child's card is lost or stolen, and of any address change.

24. I Agree with these terms:
    1. I Agree

25. Internet Use Policy
    Children 17 and under must have parental permission to use the library's internet computers. A parent or legal guardian must sign the following internet permission form at the library in the presence of a staff member. Parents/guardians of minors are responsible for supervising and monitoring their children's Internet use. Library staff cannot perform this parental function. The library provides facilities but does not take responsibility for the Internet's accuracy, timeliness or appropriateness. Users are responsible for evaluating the materials that are accessed. Much of the information retrieved may be inaccurate, offensive to some, or inappropriate for children. Parental guidance is offered in a publication called Child Safety on the Information Highway. Available at www.safekids.com

    Children 17 and under must have parental permission to use the library's internet computers. A parent or legal guardian must sign the following internet permission form at the library in the presence of a staff member. Parents/guardians of minors are responsible for supervising and monitoring their children's Internet use. Library staff cannot perform this parental function. The library provides facilities but does not take responsibility for the Internet's accuracy, timeliness or appropriateness. Users are responsible for evaluating the materials that are accessed. Much of the information retrieved may be inaccurate, offensive to some, or inappropriate for children. Parental guidance is offered in a publication called Child Safety on the Information Highway. Available at www.safekids.com

Leave This Blank:


26. 1. Receive email copy
27. Email address

28. Submit

* indicates a required field