Pollard Memorial Library Child Registration
      Children's Home

Please print this page, fill out, and bring to the Library with proof of name and current Lowell address.

Name: First___________________MI_____Last______________________________
Address: Street_____________________________________Apt#________
City_________________________State_________Zip_______________
Phone Number: (Include area code)_________________________
Date of Birth: (MM/DD/YYYY)____________________________

Circle One From Each of the Categories Below:
1. Female 2. Male
Neighborhood or Residence:
1. Acre 4. Centralville 7. Pawtucketville
2. Ayer City 5. Downtown 8. South Lowell
3. Belvidere 6. Highlands 9. Other
Birth Year Ranges:
7. 1988-1998 8. 1999 or later 9. No response

E-mail address (PRINT): ____________________________________________________
N.B. If you choose to be notified by e-mail, no paper copies will be mailed.
Ask us about "PIN" numbers.

Massachusetts State Law (G.L. c78: 7) prohibits disclosure by a public library of a patron's identity or borrowing history. The law does not differentiate among categories of library patrons and applies equally to records of minor patrons and those of adults.

By state law, public libraries may not disclose records which reveal a minor's borrowing information to the minor's parents, regardless of whether the parent is paying the fine on overdue items or the parent has signed the children's library cards. The Pollard Memorial Library will be happy to mail a list of checked-out or lost items to the cardholder's home.

 Parent's/Guardian Signature___________________________