The Library recognizes that the decision regarding what a (minor) child may view resides with the responsible adult(s).

The library will permit the loan of MPAA “R” rated titles to only those patrons who are 17 years of age or older. Proof of age may be required.

Patrons younger than 17 years of age are not permitted to borrow MPAA “R” rated titles unless written permission is on file.

Please print and sign the FORM for parental consent.

R-Rated Materials Form

By signing below I give permission for this minor to borrow "R" rated videos/DVD's from the library.

Name of Minor:
Responsible Adult:
Responsible Adult Signature:Date:
Responsible Adult ID:Date:
Staff Signature:Date: