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Applicant Information

Contact Person/Facility Information

This should be a contact we can call about requested books or missing items. This can be a family member, friend or someone at a facility in which you have regular contact.

Reason for Service Request

Why are you requesting homebound library services? (check all that apply)
Is Your Request For:
Do you have family members who could deliver materials for you?

Personal Reference

Give the name and telephone number of a person who can be used as a reference. This should be different than the Contact Person listed above.

Homebound Services Personal Preferences Survey

Select your media type preference(s) and mark as many subjects/genres that you would enjoy having.
Media Type:
Subject/Genre Fiction:
Subject/Genre Non-Fiction:
Do you object to sexual content, violence or foul language in your library materials?


By clicking the submit button I agree to the following:
I recognize that Wells County Public Library Homebound Service will uphold Indiana Codified Law 5-14-3 (as explained In WCPL Library Policy page 27) regarding confidential public library records. However, my patron records may be utilized for the purpose of selecting materials in order to supply a continually new and pertinent selection of reading/listening materials.

I understand that this application is subject to approval by library staff regarding eligibility for Homebound Delivery and Pick Up services and that approval will allow staff/volunteers to provide said services. I also understand that I will be responsible for damage or loss of library materials charged to my library card.

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