Student Card Application: R. Grant Graham Elementary

I certify that the information on this form is correct. I accept responsibility for those materials borrowed on the library card issued from this application before the applicant turns 18 years of age or otherwise becomes legally competent. Responsibility for the choice of materials borrowed rests with the person(s) who filled out this form and not with the library system or its staff

Under section 3 of the Michigan Library Privacy Act, M.C.L. 397.603, a library shall not release or disclose a library record or portion of a library record to a person without written consent of the person liable for payment for or return of the materials identified in that library record. Only the parent or legal guardian who has certified under section 2 of the Application for Minor Borrower’s Card (above), that he/she has accepted responsibility for the materials borrowed on a card, may authorize disclosure of the library records relating to that card.

By checking the box below, I signify that:
1) I am the mother/father/legal guardian of the above-named minor child and,
2) I certified on the Application for Minor Borrower’s Card in the name of the minor child named above that I would accept full responsibility for materials borrowed on the card issued to that child.