Youth Library Account Registration Form

CHILD'S NAME *

First

Last

DATE OF BIRTH *

PRONOUN

MAILING ADDRESS (STREET, TOWN & ZIP) *

RESIDENT OF? (TOWN) *

PRIMARY PHONE (AREA CODE & NUMBER) *

CELL PHONE (AREA CODE & NUMBER) *

PARENT NAME *

First

Last

PARENT'S EMAIL ADDRESS *

HOLDS NOTIFICATION PREFERENCE *

FOR TEXTS ENTER CARRIER'S NAME (EX: VERIZON OR AT&T)

WOULD YOU LIKE YOUR CHECK-OUT HISTORY TO BE SAVED AND AVAILABLE TO YOU?

YOU CAN CHANGE YOUR PREFERENCE IN YOUR ACCOUNT AT ANY TIME.

SAVED HISTORY IN

CUSTODIAL PARENT'S SIGNATURE (TYPE IN NAME)

Monday : 10AM – 8PM
Tuesday: 10AM – 8PM
Wednesday: 10AM – 8PM
Thursday: 10AM – 5PM
Friday: 10AM – 5PM
Saturday: 10AM – 2PM

We are closed most major holidays.

28 N. Main Street, Suite 2
Waterbury, VT 05676
(802) 244-7036