Library Card Application

Library Card Application
Name*

First NameMiddle InitialLast Name
Address*

Street Address

Apt, Suite, Bldg. (optional)

CityState / Province

Postal / Zip Code
Contact Phone*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Pick Identification Type*

CT Library Barcode NumberCT Driver's License
CT Library Barcode Number*
The barcode is on your public library card
CT Driver's License*
Are you a state resident or employee?*

I am a state residentI am a state employee

State Resident info
State Resident Information
Please Choose one Patron Type*

CT General Public or StudentCT Non-resident Student
About the Library Card

Your library card is for personal, non-commercial use and is non-transferable. Due to licensing restrictions, we are not permitted to share remote access with other libraries, organizations, or institutions.

About the Signature

Your signature indicates that all information you have provided is accurate, and that you have received, read and agree to abide by all applicable rules. Library User Conduct Policy
SIGNATURE OF APPLICANT*
Today's Date*

MonthDayYear
mm/dd/yyyy
Minors or Adults (Without Identification)

Please note! Minors (under 18 years of age) must have a parent or guardian's approval before being issued a card. Adults without identification must have a guarantor. In both cases, the person signing accepts responsibility for all obligations (returns, fines, replacement costs, etc.) incurred by the applicant.
Name

First NameLast Name
Address

Street Address

Apt, Suite, Bldg. (optional)

CityState

Zip Code
Zip Code
Phone Number
SIGNATURE OF APPLICANT*

State Resident Information