New Card Application

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Pines & Plains Libraries - Library Card Application (fields with an asterisk * are required)

First name *

Middle

Last name *

Date of birth *

Other name (if you go by something other than your legal name)

Preferred pick-up location *

Parent/Legal Guardian Name (if under 18)

Phone Number *

Business Phone

Fax

Email *

Address line 1 *

County of Residence *

Address line 2

City *

State *

Zip Code *

Mailing Address (if different from residence)

Mailing City

Mailing State

Mailing Zip Code

Stay up to date with our free activities. Can we email you our monthly newsletter? *

YesNo thanks

Your Patron Privacy Rights: The Pines & Plains Libraries staff members are required by Colorado Library Law (CRS24-90-119) to protect the privacy of your borrowing record. Everyone owning an Pines & Plains Libraries card is entitled to this consideration. Staff members who violate this law are subject to a misdemeanor charge and a $300 fine.

The library staff is not allowed to give your book or even the title of a book you have on hold to any other person unless you take one of the following actions:

• Give us prior permission to allow family members or other friends to pick up material for you. We will add a message with this information to your library card.

• Give your library card to the person who will pick up your book.

All information contained in your library card record is also protected under this law. Staff members are not allowed to reveal this information to anyone other than the registered patron. We cannot tell you what books other family members have checked out, or what they may owe for lost or damaged items (we do not charge late fees), unless they give us prior permission. For youths under the age of 18, the parent or guardian may be provided information about checked out materials if the primary purpose is to pay for or recover missing materials. The parent or guardian must present the youth’s library card and provide the staff with current picture identification, e.g. a driver’s license.

I have read my Patron Privacy Rights and wish to waive my rights so that other family/household members can pick up my requested library materials:

Privacy Waiver *Yes - other family/household members can use my cardNo - I wish to retain my privacy

Message (optional - this can include others who you give permission to use your card, etc.)

I will be responsible for all materials checked out on my card and/or costs incurred from lost or damaged materials. Parent/Legal Guardian is responsible for all items borrowed children's cards. If I am signing as a parent, I understand that my child will have full access to all library materials and services with their own library card.

Understood *I agree

Thank you for applying for a Pines & Plains Libraries card–your key to lifelong learning and fun through free books, movies, music, downloads, Internet access, and more. Staff may nee need a business day to receive and process your application. Please present a valid state photo I.D. during your first visit. If your current address is not on your I.D, please show us a bill or another official piece of mail (not junk mail). Applicants with an I.D. that does not list a current address will receive their card by mail. They may also check out up to two items during their first visit. For kids and some teens, a parent must sign-on as the person responsible for their account.