Library Card Application Form

First Name

Middle Name

Last Name

Mailing Address

Physical Address

Phone #

Date Of Birth

UTAH Driver’s License

E-mail address

Do you consent to being contacted via text message? (Y/N)
Yes
No

Do you wish to borrow electronic devices from the Emery County Library?(Yes/No)

If you are an educator, please list the school and grades/subjects of your assignment.

City, State

Signature

Parent/Guardian Full Name

Parent/Guardian's Mailing Address

Parent's Telephone

Birthdate of Guardian

UTAH DRIVER LICENSE OR ID

Signature of responsible party

Date