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Douro-Dummer Public Library

Patron Registration Form

First Name

Last Name

Full Address (Street Name and Number, City, Postal Code)

Phone Number

Email Address

Cardholder's Date of Birth (DD/MM/YYYY):

Is this registration for a child age 13 or younger?

Yes

If this registration is for a child age 13 or younger please provide the full name of the parent or legal guardian who will be responsible for this account.

Would you like to receive communications from the Library such as newsletter, upcoming events, new books, etc.?

Yes

I understand that borrowers are responsible for library materials charged out to them until they are returned to the library. Library borrowers are responsible for returning items by their due date. Overdue fines are in place for overdue materials.

I Agree

I Disagree

Date

Township of Douro-Dummer

Form-Builder

Douro-Dummer Public Library

Patron Registration Form

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