Land Information Memorandum Application
Section 44A of the Local Government Ofcial Information and Meetings Act 1987
1. Applicant Details
Taupiri Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 1028, Fax 07-878 7771, Email library@waitomo.govt.nz, Website www.waitomo.govt.nz/library
Waitomo District Library
Application for Membership
Surname
First Names
Email
Date of Birth
Residential Address
If dierent from above
Two forms of ID are required to complete this application. One must have your current
residential address and the other with your signature.
Proof of Residence
I.D
An alternative contact is required. This may be a friend, relative or employer and must live at a different
residential address.
Workplace / School
Address
Phone
Mobile Fax
2. Alternative Contact
Phone
Surname
First Names
Postal Address
Phone
Mobile
Postal Address
3. Parent/Legal Guardian (if applicant is under 18 years of age)
Surname
First Names
Postal Address
Phone
Mobile
Email
Relationship to
applicant
4. Member’s Undertaking
I, the applicant (full name) undertake that:
Contact No’s
The information provided in the Application for Membership is correct;
I have read, understood and accepted the Conditions of Membership;
I have read and understood the Privacy Statement;
I have authorised the Waitomo District Library to use the personal information contained in the Application for
Membership for the purposes set out in the Privacy Statement;
The alternative contact named in the Application for Membership has authorised me to give their details to Waitomo District
Library;
The parent/legal gardian who has signed the application for membership has authorised me to give their details to W
aitomo
District Library
.
Signature
Parent/Legal Guardian Signature
(if the applicant is under 18)
Date
237397 : LIB1 : 1 of 2
Conditions of Membership
1. Membership is free to all residents of the Waitomo District. Membership Cards are $2.50 payable upon
application.
2. You must present your card at the time of borrowing.
3. You are responsible for items borrowed with your card and any charges or fees that result from its use. This
includes any items borrowed by other people using the card.
4. Most book items can be borrowed for 21 days. Beyond that, overdue nes will be payable when the item is
returned. Please check the Fees and Charges Schedule for a detailed list of Library loan periods and fees.
5. You will be unable to borrow if you:
have unpaid nes or debts;
if family members living at the same address have unpaid nes or debts;
you are unable to present your library card at the time of borrowing.
6. Library staff may at their discretion, limit the number of items borrowed at one time.
7. Items may be renewed for an additional issue period if they have not been requested by another library member.
This may be done over the phone or online and the renewal fee, if any, is to be paid when the item is returned.
Items may only be renewed once. Overdue charges still apply if renewals are made after the item has become
overdue.
8. It is illegal to remove any material from the Library without rst having it issued. Offenders will be prosecuted.
9. You must notify Waitomo District Library immediately your card is lost or stolen. You are responsible for items
borrowed with the card until the time of notication.
10. To apply for membership you must supply the following forms of identication:
proof of identity (passport or other form of identication with signature and preferably being a photo ID);
proof of address (telephone account, power account or bank statement no more than 30 day old).
11. If you are under 18 years of age at the time of joining, a parent or legal guardian must also sign your Application
for Membership. Any communication regarding your membership will be with your parent or legal guardian who,
by signing your Application, agrees to be responsible for the use of your card, including any outstanding nes and
debts incurred by you.
12. Waitomo District Library is not responsible for the choice of items borrowed with your card.
13. These Conditions of Membership may change. The revised Conditions will be displayed on the Library website.
You are deemed to have had notice of such changes and agreed to be bound by the amended Conditions whilst
you are a member.
Ofce Use Only
Proof of ID:
Exp
Enrolled by
Date
Privacy Statement
1. By completing an Application for Membership you are providing personal information about you to Waitomo
District Library (Waitomo District Council). You agree that Waitomo District Library may use that information for
the purpose of:
managing your membership, including maintaining your records, advising you of overdue items, recovering
outstanding nes and debts, advising you of library services and events and contacting your nominated
contact person;
if you are under 18 years of age, discussing with your parent or legal guardian any matters arising from your
membership of Waitomo District Library.
2. The information may be given to appropriate Council staff and/or a credit agency in the event of Waitomo District
Library deciding to take action against you for the recovery of outstanding nes and debts.
3. You agree that you may be contacted by post, email or telephone (including automated telephone messages and
text messages) and the Waitomo District Library will not be responsible for third parties accessing any mail, email
or telephones messages sent to you.
4. Personal information about you will be held by Waitomo District Library. You may have access to that information
and request changes to it.
5. You are not required by law to provide personal information. However, if you do not supply the information
requested on the Application for Membership, then Waitomo District Library may be unable to process your
application.
Male/Female
Library Barcode Number
Proof ofAddress
237397 : LIB1 : 2 of 2
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