PERMISSION SLIP FOR BOOKMOBILE/LIBRARY USAGE

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.)

*Child’s Name__________________________________________

                            (Last)                           (First)

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: _________________________________________

*City___________________________

*Current valid Phone #_____________________________________

*Driver’s License #and State of issue: _______________________________

*Childs Current Grade_________                *Childs Date of Birth__________  

Click here for a printable copy of the form.