Name *

First Name

Last Name

Age Group *

Adult (18+)

Teen (14-17)

Child (0-13)

Mailing and Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number *

Please enter the area code with your phone number.

(###)

###

####

Additional Phone Number

(###)

###

####

Alternate Contact Name *

First Name

Last Name

Alternate Contact Phone Number *

(###)

###

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Membership Agreement *

I agree to abide by the policies, rules, and regulations of the Flin Flon Public Library and to accept responsibility for all items borrowed on my membership card including fines for damaged and/or lost items.

I understand that I will be unable to borrow material from the library without my membership card.

I agree that I will not lend out my membership card. If my membership card is lost or stolen, I will report it to the library immediately.

Replacement cards are $2.00 and government-issued photo ID will be required (some exceptions may apply).

Borrowing History *

I understand the Library keeps track of the library material I check out. By clicking one of the boxes below, I agree to either OPT IN or OPT OUT to my borrowing history being kept. If I choose to OPT OUT, I understand my borrowing history will be erased and I will not be able to retrieve it. I understand I can change my borrowing history choice at any time.

I OPT IN to my borrowing history being kept.

I OPT OUT of my borrowing history being kept.

Member Signature *

First Name

Last Name

Date *

MM

DD

YYYY

Parent/Guardian Name

First Name

Last Name

Date

MM

DD

YYYY