Library Card Form

You must be 18 years of age to fill out the below form. If under 18, please have your parent or legal guardian assist you with the below online form.

Personal Information

First Name: Last Name:

Home Address: City:

State: Zip:

Home Phone Number: Alternate Number:

E-mail: Alternate E-mail:

Birthday:(mm/dd/yyyy) Gender: Male Female:

Patron Type:
Pimeria Alta Student:
Pimeria Alta Parent
Pimeria Alta Teacher/Staff
Community Member
Student from other school

Parent Information (If under 18)

Mother's Full Name:

Mother's Home Number:

Mother's Cell Phone:

Father's Name:

Father's Home Phone:

Father's Cell Phone:

By clicking submit you agree that the information above is true. The information you Submit in this form is private and will not be given or sold to any private institution.

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The library is funded through the U.S. Department of Education’s Improving Literacy Through School Libraries Program

Library Card Form

Personal Information

School Information

Parent Information (If under 18)