First Grade Reader Roundup Library Card Application

Affirm that you reside within the Dexter school district (required)
—Please choose an option—YesNo

1. Applicant's Last Name (required)

Please leave this field empty.

2. Applicant's First Name (required)

3. Applicant's Middle Name - if you don't have one, write "no middle" (required)

4. Address (Number, Street, Apartment # if Applicable) (required)

5. City (required)

6. Zip Code (required)

7. Phone (required)

8. Applicant's Date of Birth (required, in this format please: MM/DD/YYYY)

9. Provide the email address of the guardian. (required)

10. What is the last name of your child's teacher? (required)

11. What is the name of your child's school? (required)
AnchorBeacon

12. Answer this statement: I certify that the information on this form is correct. I accept responsibility for those materials borrowed on the library card issued from this application. Responsibility for the choice of materials borrowed rests with the person(s) who filled out this entry form and not with the Dexter District Library or its staff. (required)—Please choose an option—YesNo

13. I certify that the information on this form is correct. I accept responsibility for those materials borrowed on the library card issued from the application before the applicant turns 18 years of age or otherwise becomes legally competent. Responsibility for the choice of materials borrowed rests with the person(s) who filled out this entry form and not with the Dexter District Library or its staff. (required)—Please choose an option—YesNo

14. Provide the full name of the guardian taking responsibility for the minor. (required)