Library Lockers Application Form

2. Thank you for your interest in using the Library Lockers at the Johnsville, Mississippi, Northtown and St. Francis libraries.

   
   

   This application is for access to the lockers outside of normal library hours with a key fob. You do not need to complete this application if you only plan to access the lockers during open hours.

   
   

   After you submit your application you will:

   • Be redirected to a confirmation page where you will be expected to read an instructional document for how to use the lockers
   • Bring a Driver’s License or other state-issued ID to the library you chose in the form to pick up your key fob

4. First Name*
5. Last Name*
7. Address Line 1*
8. Address Line 2
10. City*
11. State*
13. Zip*
15. Phone*
16. Email*
18. Library Card Number*
20. At What Library Branch Do You Want to Pick up Your Key Fob?*

    1. Johnsville Library
    2. Mississippi Library

    1. Northtown Library
    2. St. Francis Library
22. Electronic Locker Use Agreement Document

    Electronic Locker Use Agreement

    Patron is an Anoka County Library Card/Reciprocal Account holder and desires to obtain an Electronic Locker FOB to facilitate afterhours access to ACL materials under the Locker program. Patron acknowledges and agrees to the following:

    1. Patron is 18/over years of age. Patron will not allow anyone under the age of 18 to use the FOB for any purpose.
    2. Patron has a current valid ACL card/reciprocal card and has no restrictions on library usage due to unpaid fines or unacceptable conduct at the ACL or any library branch.
    3. Patron is aware of ACL rules of conduct as published on the ACL website, and agrees that those same rules of conduct control electronic locker access.
    4. Patron will use the FOB only to access the electronic lockers and will not enter or attempt to enter general library premises with the FOB.
    5. Patron acknowledges that security cameras are positioned in the area of the electronic lockers, and consents to being photographed for security purposes when using the FOB and the Electronic Lockers.
    6. Patron agrees to protect the FOB with the same care as if the FOB were a house key or business entry card. Patron will promptly notify ACL if the FOB is lost/stolen so that the FOB may be deactivated. Patron agrees to pay a $10 replacement fee for any lost FOB.
    7. Patron acknowledges that any violation of this application or ACL rules of conduct may result in the FOB’s deactivation and a $10 charge on the Patron’s ACL account.
    8. Snow and ice removal may not be complete outside of normal library operating hours.
24. Electronic Locker User Agreement*

    I have read the above Electronic Locker Use Agreement and agree to its terms. Print a Copy of the Agreement

    1. I agree
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field