Homebound Delivery Application
Emergency Contact Person
Emergency Contact Name:
Authorized to get information about the account?
Library Card Information:
I have a library card. My number is:
I don't have a library card yet. Please contact me about setting up a card.
I am unable to easily come to the library because of (check one):
Illness or disability
Preferred Delivery Day
By clicking below, I signify that I understand that I am responsible for materials delivered to me through the homebound program.
I understand and agree with the terms and conditions of the Homebound Delivery Program.
Fiction (check all that apply):
Nonfiction (check all that apply):
My favorite authors are:
Formats/Types of Materials Requested (check all that apply):
Large print books
Regular print books
TV series DVDs
Audiobooks on CD
I prefer large print books but will accept regular print books to fill my requests
I prefer paperback editions but will accept hardcover books to fill my requests
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