Testing contact form with uploads January 31, 2022 Scott Wright Uncategorized Affirm that you reside within the Dexter school district (required) —Please choose an option—YesNo Upload a copy of your driver's license or student ID with current address listed. Acceptable file types are gif, png, jpg, jpeg, and PDF. (required) 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. Email Address - If you're a parent applying for a child going to Dexter Schools, put the child's school issued email in this blank and your email in blank #14 (required) 10. Is the applicant over 16 years of age? (required) —Please choose an option—YesNo 11. If yes to #10, 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.—Please choose an option—YesNo 12. If no to #10, 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 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.—Please choose an option—YesNo 13. If no to #10, provide the full name of the guardian taking responsibility for the minor. 14. If no to #10, provide the email address of the guardian.
