Blackstone Public Library Home Bound Delivery Application Form
A Blackstone resident, who has a permanent or temporary disability, and/or is confined to his/her residence, qualifies for the Library Home Bound Delivery Program.

Delivery of materials is available every week to library patrons, who are residents of Blackstone and do not have access to the library due to permanent or temporary physical limitations. Patrons interested in the delivery service must complete the application below to ensure their eligibility. Patrons who have access to library services outside the delivery service area will not be eligible for Home Bound delivery.

Library staff is responsible for loaning, delivery, and collection of materials used in the Home Bound Outreach Program. Library staff will not enter homes.

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Name *
Address (Must be a Blackstone address to be eligible) *
Telephone Number *
Library Card Number
Email address
What types of materials are you interested in? Please check all that apply. *
Required
List magazine titles you might enjoy.
SERVICE PLAN:  Select one *
Select the genres that interest you. *
Required
By checking the box below, I certify that the information is accurate. I agree to follow the Policy and Procedures of the Home Bound Delivery Program. I understand that I am responsible for all materials borrowed as well as any loss/damaged items. I am also aware that library staff will not enter domiciles. *
Required
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