Jersey City Free Public Library

Library Card Application (Please Print or write legibly the following items of information):

Name________________________________________________________________________________________

Last First Middle or Initial

Name on Mailbox, if last name is different __________________________________________________________

Residence ____________________________________________________________________________________
                                     Number & Street and/or P.O.Box

_____________________________________________________________________________________________

City State Zip Code

Work Phone__________________________________ Home Phone__________________________________

E-mail________________________________________ Fax # ________________________________________

If you also go to a Jersey City School, please fill in the name and address of your school and the last grade completed below.

If you do not live in Jersey City and qualify for a library card because you attend school here or work here,

please provide either the school or the employment information below:

School Name __________________________________________________ Last Grade Completed_____________

School Address ________________________________________________________________________________

Number & Street Zip Code

Employer’s Name______________________________________________________________________________

Employer’s Address_____________________________________________________________________________

Number & Street Zip Code

Business E-mail__________________________________________________ Business Fax # ________________________________________

The following information will be used to help us plan our programs and services:

Birth Year ______________ Please check one _____ Male ____ Female

Check one language other than English that you would like the Library to buy books in: ___ Arabic ___ Chinese

___ French ____German ____Greek ___Gujarati ___ Hindi ___ Urdu ___Italian ___Korean ____Polish

___Russian ____Spanish ____Ukrainian ___ Tagalog

Please read and, if necessary, complete the back of this page – OVER

Two forms of ID are required, one being a Photo ID. / To be completed by Library staff member: Cut above on dotted line, and returned to Patron with new Library card.

You can access the Library Web page at http//www.jclibrary.org. Please keep the following information about your library card in a safe location:

Your PIN is _______ Your card expires __________ Barcode and User ID 2 7954___________

Name__________________________________________

Circ. Form 1 – 10/23/02 rev.

Proof of Residence is required for all applicants and non-resident students or employees will also be required to provide proof of eligibility for a free card. A recent utility bill in the name of the applicant is the best proof of residence. A tuition receipt or a student ID will provide eligibility proof for a non-resident student; and a payroll stub including the name, address and employer ID number of a Jersey City employer or an employment ID will prove eligibility for a non-resident employee.

Authorizing Library Card Issuance to Your Child or Children. Children under age 18 who reside in Jersey City are eligible for a free library card. We ask that the parent or guardian of each minor child authorize the card issuance. Please read the information in the next paragraphs, outlining your responsibilities if we issue a card to your child or children. By signing this form, you give the Library permission to issue a card to your child and agree if your child does not pay fines for late returns or lost items, you will pay for them.

You can check on the status of your child’s account with the Library through our web page

www.jclibrary.org by clicking on the Catalog link, and then on User Services, then entering your child’s user ID (barcode on card) and PIN, or by calling the Library that your child uses and giving the staff member the information. Please inform us promptly if you and your child move to a new address. Please fill out a separate form for each child.

Application for a Library Card for Your Child

I hereby authorize the Jersey City Free Public Library to issue a Library card to my child whose full name is:

Please Print ______________________________________________________________________

I acknowledge that by requesting you to issue this card, I have agreed to pay fines for late returns or charges to replace lost items, if my child does not pay these fines or charges.

______________________________________________________

Signature of parent, guardian or caregiver (please specify after signature)

To be completed by Staff (forward child applications weekly to Support for database entry).

Bar Code______________________________ PIN________________________________