Author: Sharon Chittock

Student Card Application at Fern Ridge Library
Ages 11 - 18 and Currently Enrolled in the FRSD

Student First Name:____________________________________ Student Last Name: ____________________________________________
Home Address __________________________________________________________________ City: _______________________________

Parent/Guardian Phone Number: ______________________________________

Phone Number: ____________________________________

Grade:___________ Birthday (mm/dd/yy): __________________________

School (Circle One) Elmira Elementary Veneta Elementary Fern Ridge Middle School Elmira High School

Library card # ____________________________________________________

Date Issued: _________________________________

*To make any changes to the status of this card, please have your parent/guardian sign below. When the form is returned to the Fern Ridge Library, the selected changes will be made to student card patron account. _____________________________________________________________________________________________________________________

ATTENTION PARENT/GUARDIAN your child has received a Student Card through Fern Ridge Public Library
With a Student Card, a child is allowed to borrow 3 books or movies. There are no fines for overdue materials.
All items must be returned by their due date in order for your child to check out more materials.
If materials are lost or stolen, your child is responsible for replacing or finding the materials.
This card will expire 1 year from the date it was issued.
In order to allow your child computer access while inside the Fern Ridge Library, you must sign and return this form.
To opt your child out of this card, you must contact the library: (541) 935-7512

Student Name: ____________________________________________________

Parent/Guardian Signature: ____________________________________________________ Date____________________________

Parent/Guardian Phone Number: ___________________________________

Computer Access (Circle one): YES NO

To switch this student card into a Full Access Library Card the Parent/Guardian must come into the library in-person.

Updated 6/3/26 NM