Patron Card Registration
(Please Print, Fill out and take to your nearest De Soto Trail Regional Library. Have picture I.D. with current address and you will receive a card in a few minutes.)
Name (Include First, Middle, Last):____________________
Home Phone Number: ___________________________
Work Phone Number: ____________________________
Email address: _________________________________
Social Security Number: _________________________
Birth Date: ____________________________________ Age: ____________________
Mailing Address: _______________________________
City, State, Zip:________________________________
County: _________________________
Employer: ___________________________________
Reference Name (who does NOT live in your house.):______________________
Reference Phone Number:________________________________________
Parent Name (If Younger than 18): __________________________
School Name: _____________________________________
If you are not registered to vote, would you like to vote here today?
_____ I am already registered to vote
_____ I would like to register to vote
_____ I do not wish to register to vote
I apply for the right to use the Library, agree to comply with all its rules and regulations, and give immediate notice of any change of address. I accept financial responsibility for all fines and/or damages to all Library materials and equipment beyond normal wear and tear, and I agree to pay the current replacement cost for any materials or equipment, which is lost or damaged beyond use while checked out on my card. Under Georgia Code (OCG ANNOTATED REV. 1985-20-5-53), failure to return items borrowed from a public library is considered a misdemeanor.
As a parent or guardian of a child 18 years or younger, I am willing to allow him/her to borrow books from the Public Library: I will take responsibility to make good any charges or loss to library materials and pay any fine justly charged.
Signature: _________________________________
Parent's Signature___________________________________