APPLICATION
FOR LIBRARY SERVICES
Home Service Application
A separate application must be submitted for each student; Duplicate this Application form if you need additional copies.
--------------------------------------- PLEASE PRINT ---------------------------------------
Name_________________________________________________________
Mailing Address_________________________________________________
City_________________________ State________________ ZIP__________
If applicant is a minor, please name:
Parent or guardian _______________________________________________
The books offered by the KENNETH JERNIGAN LIBRARY are available in the following Grade levels:
CHECK Only one grade level.
_____ Pre-School _____ Grade 4
_____ Kindergarten _____ Grade 5
_____ Grade 1 _____ Grade 6
_____ Grade 2 _____ Grade 7
_____ Grade 3 _____ Grade 8 (young adult)
Is subscriber:
_____ BLIND ADULT?
_____ BLIND CHILD?
Birthdate of Child (even if sighted) _____________
Signature _____________________________________ Date ____________
This application to be used only for book services directly to the home of patron.
Rules for Borrowing Books
Library service is provided either at school or home, but NOT BOTH.
Library books are distributed free of charge to subscribers for a period not to exceed 2 MONTHS. Overdue books will suspend lending privileges.
Return books to library in same mailing-box in which books were sent. It is only necessary to pull out the mailing label and reverse it. The return address is printed on the reverse side of label.
NO POSTAGE IS REQUIRED.
Books are graded by reading level. When applying for service, please be sure to include the reading level of the books you require.
Specific titles may be requested or reserved. Requested books will be sent as soon as the title becomes available.
Please call our attention to damaged books or books with missing pages.