Library Patron Check-in Form
Please complete this form to check in for your library visit and help us serve you better.
Full Name
*
First Name
Last Name
Library Card Number
*
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Check-in
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Purpose of Visit
*
Borrowing/Returning Books
Studying/Reading
Using Computers/Internet
Attending Event/Workshop
Research
Other
If you are borrowing or returning books, please list the titles and authors below.
Which library resources will you use during your visit? (Select all that apply)
Study Room
Computer/Internet Station
Printer/Copier
Children’s Area
Reference Materials
Other
Are you attending a scheduled event or workshop today?
Yes
No
If attending an event or workshop, please specify the event name.
How satisfied are you with the library's facilities today?
1
2
3
4
5
Please provide any feedback or suggestions for improving our library services.
Check In
Should be Empty: