Alternate Card-User Authorization Form

Please note: This form can be picked up at the library. Ask at the front desk.

Ardmore Public Library

Alternate Card-User Authorization Form

Pursuant to 65 O.S. § 1-105*, publicly funded libraries must maintain confidentiality of customer records. However, the statute allows you to authorize in writing another person to inspect those records.

If you would like to allow your spouse, adult child, other adult caregiver, helper, neighbor or friend to pick up your holds, check out materials on your behalf using your card, find out about what you have overdue on your account, etc., please fill out the following form. We will note this in your record and if your authorized user has your card with them, or their own photo ID, they will be allowed to do these tasks on your behalf.

You may revoke such authorization at any time by re-submitting this form and marking the “revoke” statement at the bottom of the page.

My name:  ____________________________________________________________________________

My library card number:  _________________________________________________________________

My phone number:  ____________________________________________________ (  ) home  (  ) cell

Name of authorized user:  ________________________________________________________________

Relationship to me:  ____________________________________________________________________

My Signature:  _________________________________________________________________________

Date:  ________________________________________________________________________________

       I would like to revoke the above authorization at this time.  __________ (initial) __________ (date)

* 65 O.S. § 1-105 Authorized Disclosure of Records

A. Any library which is in whole or in part supported by public funds including but not limited to public, academic, school or special libraries, and having records indicating which of its documents or other materials, regardless of format, have been loaned to or used by an identifiable individual or group shall not disclose such records to any person except to:

1. Persons acting within the scope of their duties in the administration of the library;

2. Persons authorized to inspect such records, in writing, by the individual or group; or

3. By order of a court of law.