Internet Access – Opt-Out Form | Charleston County Public Library

I do not want Internet access on the cards listed below. I understand that this will prevent usage of the public computers in a library branch. This will not prevent me or the cardholders below from using the Wi-Fi network with our own devices.

First Name

Middle Name

Last Name

Phone Number

Include area code and number using XXX-XXX-XXXX format.

Library Card Number

I would like to opt out of Internet access for:

Myself

My children under age 18

Number of Children

Child 1 Full Name

Child 1 Library Card Number or LSquared Username

Child 1 Full Name

Child 1 Library Card Number or LSquared Username

Child 2 Full Name

Child 2 Library Card Number or LSquared Username

Child 1 Full Name

Child 1 Library Card Number or LSquared Username

Child 2 Full Name

Child 2 Library Card Number or LSquared Username

Child 3 Full Name

Child 3 Library Card Number or LSquared Username

Child 1 Full Name

Child 1 Library Card Number or LSquared Username

Child 2 Full Name

Child 2 Library Card Number or LSquared Username

Child 3 Full Name

Child 3 Library Card Number or LSquared Username

Child 4 Full Name

Child 4 Library Card Number or LSquared Username

Child 1 Full Name

Child 1 Library Card Number or LSquared Username

Child 2 Full Name

Child 2 Library Card Number or LSquared Username

Child 3 Full Name

Child 3 Library Card Number or LSquared Username

Child 4 Full Name

Child 4 Library Card Number or LSquared Username

Child 5 Full Name

Child 5 Library Card Number or LSquared Username

Signature

(Please enter your full name to represent your e-signature)

Date