Belgrade Community Library
Empowering a community of lifelong learners
106 N BROADWAY
BELGRADE, MT 59714
ASSUMPTION OF FINANCIAL RESPONSIBILITY BY A MINOR
I agree to assume responsibility for all materials checked out on my account including any fines, fees, or other charges that are accrued through use of this account.
By assuming this responsibility, any guardian or other financially responsible individual previously listed on my account will be removed from the account and no longer have any financial responsibility for fines, fees, or other charges associated with this account.
No individual beside the card holder will be provided access to account information or use of this account unless granted written permission by the cardholder using the Confidential Records Disclosure form.
Patron Name Patron Library Card Number
Staff Initials for Confirmation _____________________________
This form and subsequent releases will be kept on file until otherwise requested by the patron.