Homebound Services Application

I am requesting homebound services for...

Contact Information

Will this person deliver your books?

Terms & Conditions

I certify that I have read and understand the following conditions:
  • Although overdue fines will not be charged, the patron agrees to pay for any lost or damaged materials in order to continue receiving the service.
  • Homebound Services Library Cards will be kept on file at the Library for staff to use in checking out materials.
  • I certify that I have a disability, medical condition, or age-related frailty which prevents me from using regular Public Library services.
I have read and understand the following conditions for receiving Homebound Services collections and agree on behalf of and as the authorized representative of the Center listed on this application to these conditions:
  • The Center agrees to designate one employee or volunteer as a contact person for the collection. Library staff will communicate directly with this contact person on all matters related to the collections.
  • The Center agrees to pick up and return the collections to the library. The Center will specify which individuals are authorized to pick up the materials.
  • Homebound Services Card for Centers will be kept on file at the library for staff to use in checking out materials.
  • The Center receiving Homebound Services collections from the library agrees to provide reasonable care and control so that the library materials are not damaged or lost. Although overdue fines will not be charged, collections shall be returned to the library on or before the dates specified at the time of loan. The Center agrees to pay for any lost or damaged materials in order to continue receiving the service.
Please list any managers or other individuals who are authorized to pick up materials for your center.
My condition is...
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