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Bettendorf Public Library Information Center  


LIBRARY CARD APPLICATION

First Name:   Last Name:   MI:

Street Address:

City: Bettendorf  State: IA  Zipcode: 52722

Home Phone Number:

Work Phone Number:

Cell Phone Number:

EMAIL Address:

BirthDate (MM/DD/YY):

Male: Female:

By clicking on the "Submit" button, I agree to obey all rules and regulations of the library.


Privacy Statement
The Bettendorf Public Library does not share any patron information with any outside source. All your information remains entirely confidential.


(The text below applies if you're printing this form on paper to submit)

I agree to obey all Library rules and regulations, to pay for loss of or injury to materials, to pay fines for overdue materials, and to give immediate notice of change of address or loss of Library card. Confidentiality requirements of the Iowa Code, Section 22.7(13) are hereby waived to the extent necessary for collection of overdue fines, or loss or injury to materials or equipment.

PATRON SIGNATURE:________________________________________

NOTE TO PARENT/GUARDIAN: The Code of Iowa sec. 22.7(13) provides that libraries must not reveal titles of items borrowed by other persons. Be aware that if you want information about what items your child has checked out, the child must be present to request the information.

PARENT/GUARDIAN SIGNATURE (if applicant is under 14)

PARENT/GUARDIAN NAME (please print)_________________________