Child’s Name (Please Print):

________________________________________________________________________

Last Name                                                    First Name                                       MI

Permanent Address:

________________________________________________________________________

Street                                                            City                                                    Zip

________________________________________________________________________

Phone number                                                Date of Birth                          

________________________________________________________________________

School                                                              Favorite Color J                    

The Parma Public Library has no age restrictions on any material in its collection
and does not issue cards without parental permission. The Library does not operate
in place of the parent with regards to the materials chosen by children.

Damaged materials and overdue fines accrued by the child are the responsibility
of the parent/legal guardian. Parma Public Library uses a collection agency
for debt recovery. Debts of $35 and over will be submitted to
Unique Management Systems for collection.

I understand that the library’s entire collection is accessible to children.
I give permission for my child to have a library card. In addition,
I understand that as a parent/legal guardian it is my right/responsibility to exercise
control and supervision over my child’s selection of reading materials and videos. 

______________________________________________________________________

                 Print Name                                       Signature                                               Date                           

I would like additional borrowing restrictions placed on my child’s card for DVDs
and will allow my child to borrow only ____________________________ rated films.

I understand that this is NOT a replacement for parental supervision and that
as a parent/legal guardian it is my responsibility to check the content
of library materials my children borrow. I do not hold the Parma Public Library
responsible for the borrowing choices of myself or my children.

_______________________________________________________________________

Print Name                                      Signature                                                   Date