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 Address Street Address * City * Zip Code * Home Phone * Work Phone E-Mail Address * Residency Library Use * - Select -ResidentReciprocalMichiCardNon-Resident 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 Others to Release Information To Please enter one name per line. Release of Information"Library records, formal and informal, relating to patron registration and the subsequent circulation of library materials to a patron may not be released to a third party without the written consent of a patron." (MCL 397.603). Complete this section to provide written consent. 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. 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.