Library Card Application | Montpelier Public Library

By submitting this form, I agree to be responsible for all material borrowed or used in the library, obey all policies of the library, pay any fines or damages charged to my library card, and to give prompt notice for loss of card or change of address.

Must show photo identification
Must show 1 verification of your current address (examples below)
- Utility Bill (postmarked within 30 days)
- Lease Rental Agreement or rent receipt showing address (date within 30 days)
- Current post office box receipt
- Mail that has been sent to you at your current address (postmarked within 30 days)

Today's Date

Last Name

First Name

Middle Name

Mailing Address

Mailing Address 2

City/Town

State/Province

ZIP/Postal Code

Residential Address

Residential Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Home Phone

Work Phone

Date of Birth

Parent/Guardian MUST sign below for applicants under age 18

Parent/Guardian of Minor

Home Phone

Work Phone

Street Address

Street Address 2

City/Town

State/Province

ZIP/Postal Code

Movies: check all that apply

PG-13

Please allow my minor child to check out movies of this/these rating(s)

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