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2. If you are 17 and younger, check out the Student Digital Access Card.
4. Birthdate*
   Birthdate
6. Last Name*
8. First Name*
10. Middle Name*
12. Street Address*
14. City*
16. Zip Code*
18. Email*
20. Confirm*
24. Upload Proof of Baytown Residency*

    Upload a photo or screenshot with your name and address. It can be a picture of a paper or online utility bill, car insurance registration or catalog mailing label.

28. Questions or comments?
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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