For the 2019-2020 SCHOOL YEAR
(Please print out and fill out this form. Return to Bookmobile/Library.
DL # and state of issue is required. Passport will be accepted as well. No Exceptions.)
I give permission for my child to borrow items from the
DICKINSON AREA PUBLIC LIBRARY/BOOKMOBILE
when it stops in our School District.
* My child: Please check which one applies.
____ Cannot check out Movies ____Can only check out Children movies
I have read and understand my obligations as a Parent to be responsible
for any damage or loss, and to pay any fines charged to my child’s account.
I agree to let the Dickinson Area Public Library know immediately of any and
all address or phone number changes. Contact the library at 701-456-7700.
PLEASE PRINT LEGIBLE:
*Parent/Guardian printed ______________________________________
*Parent/ Guardian Signature____________________________________
*Current valid Address: _________________________________________
*Current valid Phone #_____________________________________
*Driver’s License #and State of issue: _______________________________
*Childs Current Grade_________ *Childs Date of Birth__________