Library Service Membership

Adult application (18 years and over)

Complete this form then print off and sign the declaration and take your application and proof of identification to any Knowsley library.

Section 1: Personal details

Surname:

First name:

Title: (Mr, Mrs, Miss, Ms)

Address:

Postcode:

Date of Birth:

Telephone Number:

Please give details of your mobile and email address if you would like to be informed of library reservations and overdue items via e-mail or text messages.

Mobile Telephone Number:

E-mail Address:

Section 2: Declarations

I agree to abide by the bye-laws and regulations of Knowsley Library Service, including those relating to acceptable use of the Internet.

Signature:

I confirm that my date of birth is correct, I am 18 years of age or older and that I have read and accepted the Conditions of Membership of the Audio Visual Library.

Signature:

Section 3: Further Information

All information that you give us will be kept in strictest confidence and only used in accordance with the Data Protection Act, 1998.

3.1 Residential status, gender and customer types

A. Do you live in Knowsley? Yes No

B. What sex are you? Male Female

C. Are you a Knowsley leisure pass holder? Yes No

D. Are you a student? Yes No

E. Are you a childminder? Yes No

F. Are you a reading tutor? Yes No

3.2 Disability

Do you consider you have a disability? Yes No

If yes, can you specify what kind of impairment?

3.3 Ethnic Monitoring Categories

Please select from below the ethnic group that best describes you.

Asian or Asian British

Bangladeshi Indian Kashmiri Pakistani

Any other Asian background

Black or Black British

African Caribbean Any other Black background

Chinese, Chinese British or Other ethnic group

Chinese White Asian Any other

Mixed or Mixed British

White and Asian White and Black African White and Black Caribbean

Any other Mixed background

White

British Northern Irish Scottish Welsh English Irish

Any other White background

Gypsies and Travellers

Gypsy Irish Traveller Traveller