Library Card Application

2. *We are currently only accepting online applications from Gloucester County Citizens.* Digital Library cards for Students Only are available here: https://www.gloucesterva.info/FormCenter/Library-13/Digital-Library-Card-Application-For-Stu-81.
   Please fill out this application completely. Your Library card will be available on the next business day at the location you specify below.

   Please fill out this application completely. Your Library card will be available on the next business day at the location you specify below.

4. First Name*

5. Last Name*

6. Middle Initial*

8. Mailing Address*

10. City*

11. State*

12. Zip Code*

14. Physical Address

16. Email Address

17. Home Phone*

19. Work Phone

20. Mobile Phone

22. Voting District
    -- Select One --AbingdonGloucester PointPetsworthWareYork

23. Date of Birth*

24. If you are under 18 years old, enter your Parent or Guardian's full name

26. List your children's full name(s) who are under 18 that you would like to receive a Library Card

28. Select a Library Card
    -- Select One --Paper Card - FreePlastic Card (Credit Card Size) - $1 donation to FriendsPlastic Card (For Key Chain) - $1 donation to Friends

30. Paper Card
    

31. Plastic Credit Card
    

32. Plastic Key Chain Card
    

34. Where do you wish to pickup your Library Card?*
    -- Select One --Main LibraryPoint Library

35. I give permission for others (family members, neighbors) to check out items reserved for me.*
    -- Select One --YesNo

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field