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. 
Confirm that you live within the tax payer boundaries of Belleville, Van Buren Township, or Sumpter Township *
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Privacy Agreement: I consent to having Belleville Area District Library store my submitted information so they can respond to my inquiry. *
Is the applicant over the age of 18 years old? *



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. *
Signature of Applicant *
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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. *
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. *
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. *
Signature of Parent or Guardian *
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