Library Access School Permission Form
Complete this form to provide or update library access permissions for a student at your school.
Student Full Name
*
First Name
Last Name
Student Grade
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
Guardian Full Name
*
First Name
Last Name
Guardian Email Address
*
example@example.com
Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
School Name
*
Library Access Type
*
Full Access
During School Hours Only
After School Only
Other (please specify)
Library Access Start Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Any Library Access Restrictions?
No access to internet stations
No borrowing privileges
Supervised access only
Other (please specify)
Additional Notes or Instructions
Submit Permission
Should be Empty: