Play Card Opt-Out
**Please note: Only a student's parent/guardian may submit this form.**

Dear Parent/Guardian,

Please complete and submit this form to NOT allow your student to have a PLAY Card account with the Irwin Co/PINES Libraries.  Before doing so, please consider the many benefits of the card detailed on the ICSS PLAY Card website (https://www.irwin.k12.ga.us/page/play-card).  If this form is submitted after the initial account is created, it may take up to a month to deactivate the student’s account.

Please submit 1 form per student.  If you have more than one student you wish to opt-out, please click the "Submit another form" link which appears once you submit this form.
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Email *
Email *
Student Information
The questions below will help correctly identify the student you wish to not receive a PLAY Card account.Untitled Title
What is the student's legal first name?
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What is the student's legal last name?
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What is the student's date of birth?
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MM
/
DD
/
YYYY
What is the student's 6 digit ICSS ID number?  If you do not know it, please skip this question.

Student ID numbers are often called the student's "lunch number."  It is the same six numbers that precede the "@irwin" portion of the student's password when logging into a district provided account or device.
What grade level is the student currently in?

If this form is being submitted during summer break, please select the grade level for which the student will be in the following school year.
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Which school does the student currently attend?
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Untitled Parent/Guardian Information
The questions below will help identify that the person completing this form is a parent/guardian of the student referenced above.Title
What is your first name?
 *
What is your last name?
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What is a current phone number where you can be reached in case any question arises?

Please enter 10 digits without any spaces or other punctuation.
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By checking the box below, you acknowledge that your student will NOT have access to a PLAY Card account with the Athens-Clarke County Libraries.
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Required
Please type your first and last name below to acknowledge that you are the parent/legal guardian of the student listed above.
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Optional: If you would like, please list the reason(s) you chose to opt your student out of having a PLAY Card account.

Your response will help ICSS and the Irwin County Library make future decisions regarding this type of program offering.  Thank you!
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