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