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Central Rappahannock Regional Library: Card Application
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* Indicates required question
Student's Last Name
*
Your answer
Student's First Name:
*
Your answer
Student's Middle Initial:
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Parent or guardian first and last name
*
Your answer
Student's Local Street Address:
*
Street address with apartment number if applicable.
Your answer
City:
*
Your answer
Zip Code:
*
Your answer
City or County of Residence
*
Choose
City of Fredericksburg
Spotsylvania County
Stafford County
Westmoreland County
Other
Student's school division
*
City of Fredericksburg
Spotsylvania County Public Schools
Stafford County Public Schools
Westmoreland County Public Schools
Colonial Beach Public Schools
Other
Name of student's school
Your answer
Home Phone:
*
Your answer
Cell Phone:
*
Your answer
Email Address:
*
Your answer
Student's primary library branch is
*
Choose
Fredericksburg Branch (City of Fredericksburg)
Howell Branch (Stafford County)
Porter Branch (Stafford County)
Salem Church Branch (Spotsylvania County)
Snow Branch (Spotsylvania County)
Towne Centre Branch (Spotsylvania County)
Cooper Branch (Westmoreland County)
Montross Branch (Westmoreland County)
Newton Branch (Westmoreland County
I am completing this form because:
*
My student doesn't have a library card.
My student has lost their library card and needs a replacement.
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