Free Library of Philadelphia
 CARD APPLICATION

Send Application to:
Director of Public Services
The Free Library of Philadelphia
1901 Vine Street
Philadelphia, PA 19103-1189
FAX: 215 686-5326

For further information
Call the Public Services Office at 215-686-5389.
Visit our Web Site at http://www.library.phila.gov

Please PRINT the information requested below:
First Name_______________________________________________________________________________
Last Name_____________________________________________________Middle Initial________________
Address_________________________________________________________________________________

City____________________________________________________________________________________

State____________Zip__ __ __ __ __
Telephone (___ ___ ___) ___ ___ ___ -___ ___ ___ ___ E-mail______________________________________
Complete Birth Date: (month/day/year)_________________________________Female_______Male_________
Permanent Address if Different from Above______________________________________________________
If you live, work, go to school or own property in Philadelphia, you can get a Free Library card at no cost. Fill in the information below.
Work Address_____________________________________________________________________________
School Name___________________________________________________________________
Owned Property Locations_________________________________________________________
Current Pennsylvania Library Card_____________________________County_________________

Check only one:
_____ Adult Card: I will be responsible for any loss, damage, or fines for materials borrowed on my library card.
_____ Children's Open Card (under 12): I authorize my child to borrow any materials from the Free Library, without restriction.. I will be responsible for any loss, damage, or fines for materials borrowed on my child's library card.
_____ Children's Restricted Card (under 12): I authorize my child to borrow from the Free Library only materials selected for children. I will be responsible for any loss, damage, or fines for materials borrowed on my child's library card.

Signature: ________________________________________

Date______________

Parent or Guardian: (Signature required for children under 12)___________________________________

Date_______________