HouseCalls Registration

HouseCalls Registration
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Preferred Contact method

PhoneEmail
Emergency Contact Name and Phone Number (optional)
I understand that library staff will use my library account to check out materials on my behalf and that a record of all items checked out by me will be retained by staff during my participation in the Homebound Delivery Service.
Should be Empty: