Multiple User Library Card Application

The Denver Public Library protects your records in accordance with our privacy policy. This application allows you to waive your privacy so that additional named users who reside in your same household may pick up your holds for you. The person listed as the Primary Card Holder is responsible for all materials borrowed, and is liable for any lost or damaged materials. Furthermore, they agree to report any theft or loss of their Denver Public Library card or change of address to the Library immediately.

All additional users must reside at the same address as the Primary Card Holder and must have accounts in good standing. Please note that staff assistance is required for any Additional User attempting to check out hold shelf items on behalf of the above-listed Primary Card Holder.

Primary Card Holder Last Name

Enter name as it appears on your legal ID

Primary Card Holder First Name

Primary Card Holder Middle Name

Primary Card Holder Mailing Address

City

County

Home Phone

Mobile Phone

Your Email Address

Library Card Number

Date of Birth (MM/DD/YYYY)

Street Address (if different than the one above)

Signature

My signature above verifies that I accept responsibility for all materials on this card, and that I authorize the persons listed below to access my account for purposes of checkout and holds pickup. By submitting this form I am authorizing my electronic signature.

Additional User 1 Last Name

Additional User 1 First Name

Additional User 1 Middle Name

Additional User 1 Date of Birth (MM/DD/YYYY)

Additional User 1 Library Card Number

Additional User 2 Last Name

Additional User 2 First Name

Additional User 2 Middle Name

Additional User 2 Date of Birth (MM/DD/YYYY)

Additional User 2 Library Card Number

Additional User 3 Last Name

Additional User 3 First Name

Additional User 3 Middle Name

Additional User 3 Date of Birth (MM/DD/YYYY)

Additional User 3 Library Card Number

Additional User 4 Last Name

Additional User 4 First Name

Additional User 4 Middle Name

Additional User 4 Date of Birth (MM/DD/YYYY)

Additional User 4 Library Card Number