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Visiting Library Service Application Form

First Name:

Last Name:

Address:

City:

Postal Code:

Type of Dwelling Type of Dwelling

House

Apartment

Other

Guelph Library card number

Phone Number:

Date of Birth (mm/dd/yyyy)

Email Address:

What issues or barriers are currently preventing you from accessing the library?

Type of service: Type of service:

I have a friend or family member who will pick up for me

I do not have anyone who can pick up for me and would like delivery

Expected duration of service: Expected duration of service:

Long-Term

Seasonal

Temporary

Alternate Contact

Family member or friend who may be contacted if we are unable to reach you or in case of emergency.

Alternate Contact Name (first and last):

Relationship

Alternate Contact Phone Number:

Alternate Contact Email Address:

Material Types (Please check all that apply): Material Types (Please check all that apply):

Regular Print

Large Print

Paperbacks

Magazines

Books on CD

Playaways

DAISY Audiobooks

DVDs

Music CDs

Reader Preferences (check all that apply) Reader Preferences (check all that apply)

Mysteries

Historical Fiction

Biographies & Memoirs

Suspense/Thrillers

Westerns

Nonfiction

Romance

Fantasy & Sci-Fi

Other

General Fiction

Tell us more about what you like to read, listen to, or watch. What are some of your favourite authors or titles that you've enjoyed?

We keep a record of your reading preferences and the library materials you have borrowed in order to provide better service to you. This list and your personal information are kept confidential and are not shared.

Do we have your permission to keep this information on file and in our computers? Do we have your permission to keep this information on file and in our computers?

Yes

No

I agree to be responsible for any loss or damage of library materials delivered to me. I understand that fees will be charged for any lost or damaged material.

Yes

No

Additional Comments

Contact(s)

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