Minor Release Form Name of Minor* Library Card Number*(Under Section 3 of the Michigan Library Privacy Act, MLC 397.601 et seq., a library may not release a minor child’s library records unless the parent or legal guardian of the minor child completes and signs this form). I hereby declare that I am the above named minor's:*MotherFatherLegal GuardianConsent* I accept full responsibility for return of library material checked out by the above-named minor as well as liability for payment of the minor's overdue fines, fees, damaged or lost materials;*I give consent for the release of information of materials and fines on the minor's library record to:*NameDrivers License Number Signature* Reset signature Signature locked. Reset to sign again Full Name* Date MM slash DD slash YYYY CARD RELEASES ON MINOR'S 18th BIRTHDAY THIS RELEASE DOES NOT ALLOW THE PARENT/LEGAL GUARDIAN TO CHECK OUT MATERIAL ON MINOR'S ACCOUNT WITHOUT THE MINOR BEING PRESENT, OR WITHOUT THE MINOR'S LIBRARY CARD. Δ
