Rated R/TV-MA DVD Loan Form (for children under the age of 17)
Your child is requesting to borrow a DVD(s) that is Rated R (restricted to 17+)/TV-MA (mature audience only). The Annie Porter Ainsworth Memorial Library requires parent/guardian permission to have a child check the DVD(s) out. When this form is submitted, a corresponding note will be placed on your child’s library account. Library staff will then permit your child to borrow any DVD.
By completing this form, I understand that I am allowing my child (under the age of 17) to borrow any DVD, regardless of rating, from the Annie Porter Ainsworth Memorial Library.
Child’s Full Name ____________________
Parent’s/Guardian’s Name (please print) ___________________________________
Parent’s/Guardian’s Signature ____________________________________
Parent’s/Guardian’s Phone Number ____________________________________