3 For Me Application

Last name*

First name*

Middle initial

Child's age*

Address*

Street Address Address Line 2 City State ZIP Code

Parent's phone number

Parent's email address*

Birthdate*

Grade

School or Childcare facility*

Teacher's name and HR#*

Local branch*

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/library-card/.

Email

This field is for validation purposes and should be left unchanged.

3 For Me Library Card Application

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