Waltham Public Library Registration Application
The Waltham Public Library is a member of the Minuteman Library Network
NAME _________________________ / _________________________ / ______________________________________
(First)
(Middle)
DATE OF BIRTH _______________________
M
(Last)
F
SCHOOL________________________________
If you are living here temporarily, please let us know approximately when you are leaving,
so we can expire your card properly:_________________________________
The library will not disclose, share or sell your personal information.
LOCAL MAILING ADDRESS
PERMANENT ADDRESS (if different from local)
STREET _______________________________________
STREET _______________________________________
APT ___________________ P.O. BOX ______________
APT ___________________ P.O. BOX ______________
TOWN/CITY ___________________________________
TOWN/CITY ___________________________________
STATE _________________ ZIP __________________
STATE _________________ ZIP __________________
HOME PHONE _________ / ______________________
HOME PHONE _________ / ______________________
OTHER PHONE ________ / ______________________
OTHER PHONE ________ / ______________________
If you would like to be notified when your reserves arrive or receive courtesy notices before items become overdue, please give
us your email address:
EMAIL ADDRESS – Please print clearly! _____________________________________________________
ASK FOR A PIN (Personal Identification Number) if you would like access to your library account online.
______Check here to be added to our monthly email for events.
Waltham Public Library Borrower Agreement
IMPORTANT: You are responsible for any materials borrowed on your library card account.
Please be aware that your card should not be shared with anyone else. If your library card should be lost or stolen, please
report it immediately to prevent theft of library materials on your account.
Massachusetts General Law Chapter 78, Section 7 states “That part of the records of a Public Library which reveals the
identity and intellectual pursuits of a person using such a library shall not be a public record as deemed by clause Twentysixth of section seven of chapter four.”
____________________________________________________________________________
By signing the above I accept responsibility for all library materials borrowed on this library card account. I agree to report the
loss of my library card immediately. This applies to the double cards (key chain and wallet size) as well as the single cards.
SIGNATURE
STAFF USE ONLY
Date ____________________
Staff Initials _______
Barcode _________________________________________________________________________
ID Checked _______
New Registration
Change of Info
Exp. Date, if different _____________