Form Ms 96-0201 - Library Card Application/renewal Form - Hawaii State Public Library System

Download a blank fillable Form Ms 96-0201 - Library Card Application/renewal Form - Hawaii State Public Library System in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Ms 96-0201 - Library Card Application/renewal Form - Hawaii State Public Library System with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Residents must provide current valid ID and proof of mailing address.

Non-residents must provide valid ID, temporary address and proof of permanent address.

Free:  Resident

 Military personnel & dependents stationed in Hawaii

Fee (Non-Resident):  $25 (valid 5 years)

 $10 (valid 3 months)

Replacement Card:  $5

 Please Print Full Legal Name

Name

___________________________________________________________________________________________________________________________________

LAST

FIRST

MIDDLE

Local mailing address

________________________________________________________________________________________________________________

STREET OR P.O. NO.

APT. NO.

City

State

Zip

_____________________________________________________________

____________________________________

_____________________

Telephone

(Home)

(Business)

(Cell)

_________________________________

Preferred Notification of Reserved or Overdue items (check one only):

 E-mail

 Postal mail

E-mail address

________________________________________________________

 Please fill out this section only if you are a Non-Resident.

Effective dates for local address:

From

__________/__________/__________

MONTH

DAY

YEAR

MONTH

DAY

YEAR

Out-of-State mailing address

______________________________________________________________________________________________________

STREET OR P.O. NO.

APT. NO.

City

State

Zip

_____________________________________________________________

____________________________________

_____________________

 Please fill out this section if you are under 18. Parent/Guardian ID and signature required for child under 18.

Minor's Birthdate

__________/__________/__________

MONTH

DAY

YEAR

Parent/Guardian’s name

___________________________________________________________________________________________________________

LAST

FIRST

MIDDLE

Mailing address

___________________________________________________________________________________________________

(If different from Minor's)

STREET OR P.O. NO.

APT. NO.

City

State

Zip

_____________________________________________________________

____________________________________

_____________________

 No Internet Access: I do not want my child (under 18) to use the Internet in a public library.

 Signature is required to receive a library card:

I attest that the information on this application is true and correct. My signature on this card indicates my agreement to follow the Library’s

rules and policies in exchange for access to the Library’s collections and services. I accept responsibility for all the materials charged to this card,

including fines, fees, and charges assessed to it. I shall promptly notify HSPLS of any changes to my library account information, including but

not limited to, mailing and/or email addresses, or name change. I will report loss or theft of this card and understand that I may be responsible

for library material borrowed with a lost or stolen card. I have been provided with a copy of the HSPLS library card terms and conditions.

_______________________________________________________

__________________

Staff Use Only>

APPLICANT'S SIGNATURE

DATE

___________________________________________________

I attest that I am the applicant’s parent/guardian and will be financially responsible

CUSTOMER BARCODE #

for borrowed materials, fines, fees, and charges associated with the use of this card.