HomeWord Bound Form

At least one of these must apply: *

Short-term disability
Long-term disability
Illness which confines individual to their home
75 years or older

If you qualify for HomeWord Bound services, please provide the following contact information:

Should library staff contact the person helping to fill out this form about applicant's reading preferences?

yes
no

* By selecting this checkbox I understand and agree to the following statements: If I lose or damage an item I am responsible for the replacement cost. I understand I will be notified of overdue items on my account and will return them promptly. My library account and personal information will be kept on file at the Library. Staff and volunteers will access my account and use functions such as 'My Reading History' to manage my selections. I may become ineligible for the program if circumstances change or I am unable to abide by the guideslines set forth.

HomeWord Bound

If you qualify for HomeWord Bound services, please provide the following contact information:

Services