By submitting this form, I authorized the above agent to check out library material in my name. I understand that I will be responsible for all such material checked out by my agent, including any charges for lost or damaged material. I understand my agent will have full access to my library record and I authorize the library to disclose information related to my library record to this individual. If this person is no longer acting as my agent, I will notify the library immediately. I understand I will be held responsible for all materials borrowed prior to such notification. Completing this form and submitting acts as a signature.