3 For Me Application Last name* First name* Middle initial Child's age* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home phoneMobile phoneEmail 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