Library Card Application Form

First Name

Middle Name

Last Name

Mailing Address

Physical Address

Phone Number

Date of Birth

Utah Driver License or ID Number

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

Yes

Mobile Phone Carrier Other Value

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

To Be Completed By Parent/Guardian/Responsible Party Over 18 Years Of Age For Minor App

Parent/Guardian Full Name

Parent/Guardian's Mailing Address

Parent/Guardian's Phone Number

Date of Birth of Parent/Guardian

Utah Driver License or ID

Signature of Responsible Party

Date