Adams Public Library
P.O. Box 20/190 North Main Street
Adams, Oregon 97810
www.cityofadamsoregon.com

The front page must be completed by an adult.
If the application is for a youth under the age of 18-
an adult completes the application front page and part B then the minor signs part A.
Please read the loan rules available at the library or our website.
All sections of the application must be complete to receive a card.

Library Card Application/Update Today’s Date : / /
Borrower's cards for permanent residents will expire after three years. If not renewed or reactivated within three years after the expiration date, the record will be deleted from the database unless there are unresolved blocks on the account.
Applicant’s Name: Last First M.I.
Mailing Address:
P.O. Box City State Zip Code
Street Address
House Number/Street Name City State Zip Code
Home Phone: Cellular Phone: Work Phone:
E-mail: Date of Birth: / /

Reference: a person who does not live with you, is over the age of 18 and would know how to contact you if the library was unable to contact you with the information given above.
Name: , Last First M.I.
Mailing Address:
P.O. Box City State Zip Code
Street Address
House Number/Street Name City State Zip Code
Home Phone: Cellular Phone:

Identification and Proof of Residency-must be shown to the librarian.
Driver’s License # £ Number_________________
DMV Identification card £ Number_________________
Voter registration £ Number_________________
Utility Bill £
Other_______________________________________________

Continue on back-

BORROWER’S AGREEMENT
I agree:
● To be responsible for all materials borrowed with my card including computer and internet use.
● To pay all fines and fees associated with my card.
● To report the loss, theft, or abuse of my card immediately. I understand that I am responsible for all fines and fees and any items checked out on my card prior to being reported lost or stolen.
To report changes in my account information.
That I have read and will abide by the Umatilla County Special Library District County Wide Standardized Loan Rules.
Providing false information in this application is a felony of the third degree punishable by up to five years in prison and a fine of up to $10,000. ORC 2913.42.
(Please Print) _______________________________ ___________________________________ ___ __
(Last) (First) (MI)
Your Signature:
X _____________________________________________________________ Date_______________________
PARENT/GUARDIAN AGREEMENT
As a parent or legal guardian of this borrower under the age of eighteen, I agree:
● To be responsible for this borrower’s selection and use of library materials including computers and internet use .
● To pay all fines and fees associated with this card.
● To report the loss, theft, or abuse of this card immediately. I understand that I am responsible for all fines and fees and any items checked out on this card prior to being reported lost or stolen.
● To report changes in this account’s information.
Providing false information in this application is a felony of the third degree punishable by up to five years in prison and a fine of up to $10,000. ORC 2913.42.
That I have read and will abide by the Umatilla County Special Library District County Wide Standardized Loan Rules.
Name and Signature of Parent/Guardian:
(Please Print) _______________________________ ___________________________________ ___ __
(Last) (First) (MI)
(Please Sign) X___________________________________________________________ Date_________________

Office Use Only
£New Application £ Update

Library Card Number

Affix Barcode Here

Please return to the Adams Public Library with parent/ Guardian identification and proof of residency to receive your new library card.
You must bring your library card with you to the library to check out items or use computers.