By signing up for a Cromaine library card online, I agree to be responsible for all materials borrowed against my card. I will notify the library immediately if my address changes or if my card is lost. Contact InformationName Last Name * First Name * Middle Initial Driver's License Number Address Street Address * City * Zip Code * Home Phone * Work Phone E-Mail Address * Statement of Financial Responsibility 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) whose signature(s) appear on the line below and not with the library system or staff. Full Name * Residency Library District Resident Since - None -Before 19951996 - 20002001 - 20052006 - 2011 Home Library (if Non-Resident) Other Information and Preferences Please help the library save costs by using e-mail. I prefer to receive library notices (request materials on hold, overdue notices, etc.) via * E-Mail Phone Mail Township * - Select -HartlandBrightonDeerfieldGenoaOceolaTyroneOther Sex - None -FemaleMale Year of Birth * Minor's Library Records and Parent / Legal GuardianI certify that the information on this application is correct and that I am the parent of legal guardian of the applicant. I accept full responsibility for return of library materials checked out by the above-named child, as well as liability for payment for any damaged or lost materials. I accept responsibility for my child's use of any and all library materials, including the Internet. Any restriction on my child's library use is my responsibility. I authorize the library to release information to me and to the listed person(s) about the applicant's overdue and lost materials. Parent / Guardian's Name Parent / Guardian's Driver's License Number Others to Release Information To Please enter one name per line. Release of Records to Other Adults/Household MembersUnder Michigan Public Act 188 f 1996, library records may be disclosed upon the consent of the person who is liable for payment for or return of the materials identified in that library record. I, Last Name First Name do hereby grant permission to the Cromaine District Library to release information regarding my library records to the following person(s): Others to Release Information To Please enter one name per line. Complete this section only if nonresident working within Hartland School District boundaries. Business Name Street Address City Business address verified on map. - None -YesNo Verification * Type the characters you see in the picture; if you can't read them, submit the form and a new image will be generated. Not case sensitive. Switch to audio verification.