Member/guarantor details Title - None -DameDrLadyLordMissMrMrsMsMxRevSir First name Last name Date of birth Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Address line 1 Address line 2 Address line 3 Town Post code Phone number Email Additional child family member details Child member details ChildFirst nameLast nameDate of birth Child Child 1 First name Last name Date of birth Child Child 2 First name Last name Date of birth Child Child 3 First name Last name Date of birth Additional membership options If you wish your child to be able to use the Computing and Internet Services, please read - A Parent & Carer’s Guide to the Internet. As parent/guardian of the individual/s named above, I give him/her permission to use the services indicated below ChildServices Available Child Child 1 Services Available Internet Console games hire Child Child 2 Services Available Internet Console games hire Child Child 3 Services Available Internet Console games hire Collection of membership card Please select the library you would like to collect your membership card from - None - Bishopbriggs Library Bearsden Library Craighead Library Lennoxtown Library Lenzie Library Milngavie Library Westerton Library William Patrick Library Declaration For Information on our full membership terms and conditions and acceptable use policy As guarantor, you will also be required to sign this form and provide a document showing proof of your name and address, such as an electricity bill or a driving licence when you collect this library membership card. Confirmation I wish to apply for membership of East Dunbartonshire Libraries. I agree to be bound by the Libraries’ Membership Card Conditions of Use and to abide by the guidelines regarding the use of East Dunbartonshire Leisure & Culture Trust’s Computing and Internet provision in public buildings Data Protection The information on this form will be processed by East Dunbartonshire Leisure and Culture Trust in accordance with the General Data Protection Regulation. The data you provide will be used for administering your library membership and for statistical purposes. We will not pass any data you provide to a third party other than for administration of your membership. Please review the attached Privacy Notice Privacy Statement Read * I have read the privacy statement.