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Homebound Delivery Services Signup

Please fill out the form below to request homebound services.

 

Personal Information

* First Name

* Last Name

* Email

* Phone Number

Preferences


* Notification Preference
Please select your preferred method of contact

Delivery Preference
Please indicate your general availability for deliveries
   Afternoon
   Morning

* Reason for Request
Please briefly describe your reason for requesting homebound library services. (e.g., disability, illness, etc.)

Additional Information
Please let us know if there are any special instructions or considerations for deliveries.

Terms and Conditions

  * By submitting this form, I certify that I am eligible for homebound library services due to a qualifying disability or illness. I understand that delivery dates and times will be determined by library staff and may vary. I also agree to abide by library policies and procedures.