Full Service Card form Upgrade to a Full-Service Library Card I would like to:Select all that apply Upgrade e-card to full-access card Renew my card Get a replacement card Report a Lost or Stolen Card eCard or current account numberPerson named on the account First Middle (Optional) Last Phone (Optional)Email Address on account Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Select your preferred library locationAntiochBay PointBrentwoodClaytonConcordCrockettDanvilleDougherty StationEl CerritoEl SobranteHerculesKensingtonLafayetteMartinezMoragaOakleyOrindaPinolePittsburgPleasant HillPrewettRodeoSan PabloSan RamonWalnut CreekYgnacio ValleyAre you requesting this on behalf of yourself?Yes, this is for meNo, I am requesting on behalf of someone elseName of requestor if different from the person named aboveRelation to person named on the accountRequestor phone number (if different from above, optional)Requestor email address (if different from above) Library Card StyleSelect one from the six choicesDo you have pending requests in OverDrive?YesNoDo you have pending reservations for Discover & Go Museum passes?YesNoAttach verificationAttach a copy of a utility bill that includes cardholder name and address. (Parent may provide one with their name if cardholder is a minor) If utility bill does not match name on account, also attach an image of a piece of mail addressed to cardholder postmarked within past 30 days. Students may attach a copy of mailing info from student report card or other school correspondence which includes their name. Drop files here or Accepted file types: jpg, gif, png, pdf, jpeg. Maximum file size - 30 mega bytes. Is this for a cardholder 12 and underYesNoParent ConsentWe are pleased that your child has requested a library card from the Contra Costa County Library. Obtaining a library card is an important stage of growth for most young people. We hope that this is the beginning of a long and friendly relationship between your child and the library. As a parent or guardian, there are policies of the Contra Costa County Library that we want to bring to your attention before your child completes a library card application. Since this is a "contract" with a minor, we do require your signature. It is important that you understand that in signing, you accept financial responsibility for any materials checked out on the card. With this card your child has access to all resources of our library. The library staff will not restrict the child's choice of books or use of other library materials. It is our policy to serve people of all ages with a broad selection of library materials to satisfy the informational needs of citizens of Contra Costa County. Libraries contain some printed, audiovisual, and electronic materials, which some parents occasionally find objectionable or inappropriate for their children. Because our staff does not monitor the choices a child makes, we suggest that you may wish to be aware of what materials your child borrows from the library. The responsibility for any restrictions on a child's borrowing privileges rests with the parent or guardian. In order to guarantee privacy for each individual, California law mandates confidentiality of registration and borrowing records, and Contra Costa County Library policies and procedures carry out that intent. Library staff cannot give any information about a patron's registration and circulation record to anyone other than the patron, no matter what the age or relationship to the patron. For example, a parent cannot be told what material a child has checked out on the child's card without the child's consent. We look forward to many years of service to your family in meeting your reading and information needs. As a parent or legal guardian, I agree to be responsible for my child’s reading and viewing materials under the library’s policy on patron confidentialityYesNoPerson named on account acknowledges they are aware of and approve this requestCardholder InitialsYesNoDisclaimerWe are unable to provide full-service library cards remotely if cardholders cannot meet the above requirements.NameThis field is for validation purposes and should be left unchanged. Close Can you tell me more about this webform submission? The contents of this webform are sent to library staff via email. We recommend that you do not submit confidential information (like your library card number, passwords or credit card information). If you need to share confidential information with library staff, we suggest that you use other channels of communication, such as the telephone.Visit our Privacy Statement, opens in a new window to learn more about how your personal information is handled and protected. This information will be submitted via email. Learn More about sending data over email. This iframe contains the logic required to handle Ajax powered Gravity Forms.