Mount Holly Town Library is a public library serving the Mount Holly community There is no fee to join.
Patron Application for Use of the Mount Holly Town Library
(One application per family please)
To obtain a borrower’s card, you will need to complete this form. PLEASE UNDERSTAND THAT MATERIAL CANNOT BE CHECKED OUT UNTIL YOUR LIBRARY CARD IS ACTIVATED.
PLEASE PRINT CLEARLY
1.) Last Name_______________________________
First Name_________________________________
VERMONT ADDRESS
Street or PO Box___________________________
Town___________________ Zip Code_________
Email address______________________________________________
Telephone____________________________ Cell__________________________________
Gender: M F (circle one) Birth Date if under 18 (month/day/year) _____/_____/_______
2.) Circle One
Permanent Home Second Home Owner Long term Rental Short Term Rental
If you are a short term rental whose property are you renting? ___________________________
*3.) Out of State Address (required for second home owners and renters)Street address, apartment # (mailing address)______________________________________________________
Town____________________State ______Zip Code______________
Telephone__________________________ Cell_____________________________________
Email address______________________________________________
I agree to comply with all Mount Holly Town Library patron guidelines and procedures.
I accept financial responsibility for all damages or loss of Library materials, audiovisual materials and equipment beyond normal wear and tear. As the parent or guardian of a child 18 years or younger, I am willing to allow him/her to borrow materials from the Mount Holly Library. I will take responsibility and make good any charges or loss to library materials.
If under 18 parent or guardian must sign.
The information on this form will be used for library purpose only and is considered confidential.
Signature: ____________________________________Date:______________
**Staff and volunteer must fill out: Date registered __________
Initials of volunteer ________
For librarian use only: Barcode___________________
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Mount Holly Town Library 