First Grade Round Up Card Application

Hello Parents and Caregivers!

Please complete this form just for your first grader. If you, or any other members of your family, would like a card you can use this other form for those requests.

"*" indicates required fields

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

School Name*

Teacher's LAST NAME*

CHILD's Name*

First Last

Does your child already have a library card?*

Yes

Enter child's library card #

If your child's library card is lost, please skip the library card # field and check this box. If you have your child's card, please enter the number in the field above and skip this box.

Lost

Is it a Canton library card?

Yes

Please tell us what library the card is from.

If it is a reciprocal library, and not lost, we will register this card in our system. Otherwise, we will issue your child a Canton card.

Child's Address*

Street Address City State / Province / Region ZIP / Postal Code

Child's Birthdate*

Please enter your child's birthdate. This number without slashes will also be their PIN (MMDDYYYY).

Name of Parent/Guardian*

The parent or guardian that signs this form is responsible for the use of this card and any related charges per the library’s policies and is legally responsible for all materials borrowed on this card. Library staff will not monitor the use of this card and the borrowing of materials and/or computer usage on this account.

First Last

Parent/Guardian Phone*

Parent/Guardian Email

Enter Email Confirm Email

Would you like to add additional authorized users to the account?

We recommend adding the names of all parents/guardians.

Yes

I acknowledge and agree to follow the library's policies.

Additional Authorized Users

Please write as first name last name and, if adding multiple, separate names with a comma.

About Authorized Access:

It is the policy of the Canton Public Library that all library records are kept confidential and only shared with the cardholder and/or as a result of appropriate legal orders. If you wish others to have access to your child's account, please indicate below: I agree that the following individuals have the ability to pay fees and/or pick up held items on this account with proper identification. All other account information will remain confidential. I can change or void this list at any time by presenting identification to the library and requesting that individuals be removed or added to the list. Please check the box to confirm your understanding.

I acknowledge and agree to follow the library's policies.

This information will be submitted via email. .