Belleville Area District Library Card Application

Please fill out the form below to apply for a Belleville Library card. We will provide your card through the mail, or contact you with next steps if needed.

In order to receive your card, we require proof of residency (such as a current drivers’ license or state ID) to complete the registration process.

This form and any files uploaded to it are encrypted for security.

First Name *

Middle Name

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Date of Birth * +

Phone Number *

Email Address

City or Township where you pay your taxes: *

City of Belleville

Sumpter Township

Van Buren Township

Other Other

Please select the option that applies: *

I am a student in Belleville, Van Buren, or Sumpter

I teach in Belleville, Van Buren, or Sumpter

I work in Belleville, Van Buren, or Sumpter

None of these applies

School Name *

School Address *

Please upload a picture of the school ID *

School Phone Number *

School Email Address *

Please upload a school ID or proof of employment

Name of Employing Company *

Address of Employing Company *

Phone Number of Employing Company *

Email for Employing Company *

Please upload a picture of a business ID or other proof of employment within Belleville, Sumpter, or Van Buren

Please provide the best phone number for contacting you and someone will reach out about your library card options *

Privacy Agreement: I consent to having Belleville Area District Library store my submitted information so they can respond to my inquiry. *

Yes

Is the applicant over the age of 18 years old? *

Yes

No

Please submit a picture of the FRONT of your driver's license or state ID (maximum file size 20 MB)

Please submit a picture of the BACK of your driver's license or state ID (maximum file size 20 MB) *

If your license or state ID does not show a Belleville, Van Buren, or Sumpter address because you have just moved, please ALSO provide a picture of a utility bill or bank statement with your new address. Proof of residency in our tax payer boundaries is required to issue a Belleville Area District Library card. If utilizing this option, a valid state ID is still required. (maximum file size 20 MB)

I certify that the information on this form is correct. I accept responsibility for those materials borrowed on the library card issued from this application. Responsibility for the choice of materials borrowed rests with the person(s) who filled out this entry form and not with the Belleville Area District Library or its staff. *

I agree

I do not agree

Signature of Applicant *

clear

Please provide the full name of parent or guardian. *

Relationship to the minor applicant *

Please submit a picture of the FRONT of the Driver's License or State ID for the parent or guardian (maximum file size 20 MB) *

Please submit a picture of the BACK of the Driver's License or State ID for the parent or guardian (maximum file size 20 MB) *

If your license or state ID does not show a Belleville, Van Buren, or Sumpter address because you have just moved, please ALSO provide a picture of a utility bill or bank statement with your new address. Proof of residency in our tax payer boundaries is required to issue a library card. If utilizing this option, a valid State ID is still required. (maximum file size 20 MB)

Disclosure: Under Michigan Public Act 188 of 1996, library records may be disclosed upon the consent of the person who is liable for payment for or return of the materials identified in that library record. Where the applicant is under 18 or otherwise legally incompetent, the library records under a card issued to that applicant can be released upon written consent of the parent or legal guardian who signed this application. *

I agree

I do not agree

Release of Minor Child’s Library Records: Under Section 3 of the Michigan Library Privacy Act, M. C. L. 397.603, a library shall not release or disclose a library record or portion of a library record to a person without the written consent of the person liable for payment for or return of the materials identified in that library record. *

I agree

I do not agree

Statement of Responsibility: I certify that the information on this form is correct. Responsibility for the choice of materials borrowed rests with the person(s) whose signature(s) appear on the line below and not with the library system or its staff. The legal guardian accepts full responsibility for those materials borrowed on the library card issued from this application before the applicant turns 18 years of age or otherwise becomes legally competent. I am a legal guardian of the minor applicant whose name appears on this form. I give consent for the release of the child’s library records to myself. *

I agree

I do not agree

Signature of Parent or Guardian *

clear