Cross Plains Public Library

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Internet Use Contract

Name:_____________________________________________________________

               (Last)                                    (First)                          (Middle Initial)          

Address:___________________________________________________________

                        (Street Address and Mailing Address if different)

City, State, & Zip Code:________________________________   Phone:_________________

Date of Birth (if under 18):______________________

I have read, understand, and accept the Cross Plains Public Library Internet Use Policy and Guidelines as adopted on August 8, 2005.

Signature:__________________________________________

Signature of Parent/Guardian (if less than 18 years of age): ____________________________

Adopted by the Board August 8, 2005