Belgrade Community Library

Empowering a community of lifelong learners

 

106 N BROADWAY

BELGRADE, MT 59714

(406)388-4346

www.belgradelibrary.org

 

CONFIDENTIAL RECORDS DISCLOSURE REQUEST FORM

 

RELEASE TO ALLOW EXAMINATION OF LIBRARY RECORDS

 

By my signature below I give written consent for Belgrade Community Library to disclose my library records and grant use of my library account to the person(s) listed.

 

I understand that I must give written permission to release my library records.

 

I understand that Article II Part II Section 15 of the Montana Constitution states: "Rights of persons not adults. The rights of persons under 18 years of age shall include, but not be limited to, all the fundamental rights of this Article unless specifically precluded by laws which enhance the protection of such persons."

 

PLEASE PRINT

 


My Name

 

                                                                                               

My Library Card Number

 

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Name of the person(s) my library record(s) may be released to:

 

________________________________________________________________________                                               

 

________________________________________________________________________                                               

 

________________________________________________________________________                                               

 

Signature

 

________________________________________________________________________                                               


Date

 

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This form and subsequent releases will be kept on file until otherwise requested by patron.