Please print clearly and complete all applicable fields.

Applicant Information

Name: {field:name_1763446304191}

Mailing Address: {field:mailing_address_1763446936195}

Home Phone (required): {field:home_phone_1763447018510} Cell (text): {field:cell_text_1763448432129}

Email (no school emails): {field:email_address_no_school_emails_1763448450006}

Events Newsletter: {field:events_newsletter_1763448040998}

Preferred Notification Method: {field:preferred_notification_method_1763447830308}

I understand I am responsible for all materials checked out on this card and any fines or replacement costs for lost or damaged items. I agree to comply with all library policies and acknowledge the confidentiality of library records under NH RSA 201-D:11.

Children: {field:no_of_childs_1763564899870} {field:children_1763564657492}

Adults: {field:adults_1763564779631}

Patron Signature: {field:patron_signature_1764006381856} Date: {other:date}

(Child must be present if applying for a child card.)
Patrons 12 and under need parent/guardian permission to receive a library card.

By signing below, you authorize the library to issue an independent card to your child. You understand that library records are confidential and will not be disclosed to you. You also agree to be responsible for any fines or fees for lost or damaged items incurred by your child.

Parent/Guardian Signature: {field:parent_guardian_signature_1764006394438} Date: {other:date}

For Library Use Only

Library Card Number: _____________________________

Staff Initials: ____________ Date Issued: _______________

Proof of Residency Verified: ☐ Yes ☐ No

Monday:	Closed
Tuesday:	9:30 AM – 7:00 PM
Wednesday:	9:30 AM – 7:00 PM
Thursday:	9:30 AM – 7:00 PM
Friday:	1:30 PM – 5:00 PM
Saturday:	9:30 AM – 1:30 PM
Sunday:	Closed