Forms • City of East Grand Forks • CivicEngage

Homebound Delivery Service

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Yes, I am interested in the East Grand Forks Campbell Library’s Homebound Delivery Service. I understand that this application is subject to approval by library staff regarding eligibility for Homebound Delivery Services and that approval will allow staff and volunteers to provide said service. Upon approval of the application, Campbell Library will provide a library card, if needed, for me with the understanding that I am responsible for damage, or loss of library materials charged to this library card

Patron Name:*

Library Card #:

Address:*

Phone Number:*

Do you have access to Internet/Computer?*

Group facility name and phone (if applicable)

2nd contact person name & phone

Volunteers will deliver books to your door but not enter your home. What delivery preference would you prefer?*

	Ring doorbell to hand off books to someone in the home
	Leave books in between storm and entry door

Ring doorbell and leave books inside door

Please expand or add additional comment, if necessary.

I understand that the library staff will select materials for my use, check materials out to me for a loan period, and that the library will arrange to have staff/volunteer deliver the materials to my home at a scheduled time.

I understand that the staff/volunteer assigned will deliver my books according to request on a scheduled basis. Volunteers will not come into my home and will not be available to provide assistance with any activities of daily living or advice on financial or personal matters.

I understand that the program is supervised by the library staff and any problems or conflicts will staff or volunteers should be reported to the Library Director. I also understand that I may become ineligible for this program if I do not abide by the guideline set forth.

Please initial and date

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