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Library Card Application - Under Age 13

2. I am the parent/legal guardian of a child under the age of 13, and*

   1. applying for their first Moline Public Library card.
   2. renewing their expired Moline Public Library card.
   3. replacing their lost or stolen Moline Public Library card ($3 replacement fee due upon activation of card).

4. Child's Last Name*

5. Child's First Name*

6. Child's Middle Initial

8. Parent/Legal Guardian's Last Name*

9. Parent/Legal Guardian's First Name*

10. Parent/Legal Guardian's Middle Initial

12. Street Address*

14. City*

    Non-Moline residents are ineligible to apply.

15. Birthdate*
    Birthdate

    Applicant must be under 13 years old. For parents or guardians applying on behalf of their child, please use Library Card Application - Ages 13 and Older.

17. Email Address*

18. Telephone Number (with Area Code)*

20. How would you like receive notices for available holds or overdue items?*

    1. phone
    2. e-mail (includes courtesy reminder notices 3 days before items are due)

22. I will obey all rules and regulations of the Library, pay fines for any lost or damaged items borrowed on my card, and give immediate notice of change of address. *

    1. I agree.
24. I understand that the Illinois Library Records Confidentiality Act (75 ILCS 70) prohibits library employees from sharing information with parents or legal guardians about what children have checked out or requested from the library.*

    1. I agree.

26. By providing my email address, I agree that I will receive occasional email communication from the Moline Public Library. *

    You may unsubscribe any time from the footer of any e-mail. The library will never share, distribute, or sell your e-mail address.

    1. I agree.
28. To activate this card as the applying parent/legal guardian, I will present valid photo ID and proof of residency at the Moline Public Library AND have the child present. *

    1. I agree.

30. PLEASE READ
    Moline Public Library Circulation Policy

    Includes more information on children & privacy, lost & damged items.

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field