3 For Me Application Last name* First name* Middle initial Child's age* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home phoneMobile phoneEmail eNewsletters The Library maintains an engaging eNewsletter about collections, events, and services. Check the box if you do NOT want to receive these email messages. Birthdate* MM slash DD slash YYYY Grade* School* Teacher's name and HR#* Local branch* Amelia Batavia Bethel Felicity Goshen Miami Township New Richmond Owensville Union Township Williamsburg Electronic signature of parent or guardian* My child and I agree to take good care of the items checked out on the 3 For Me card and return them to the Library when they are due. By typing my name here, I agree to all borrowing guidelines that can be found at https://clermontlibrary.org/3-for-me/. Δ