Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of Birth (dd/mm/yyyy) *Phone Number *Email (optional)Home address for delivery of library materials *Emergency Contact (name) *Emergency Contact (phone number) *Format of materials you are interested in (select all that apply): *BookMagazineAudiobook on CDDVDMusic CDGame/PuzzleOtherIf you selected "other" above, please elaborate (optional):I require large print books: *YesNoI have a print disability (A print disability can be an impairment relating to comprehension, inability to hold or manipulate a book, severe or total impairment of sight or the inability to focus or move one’s eyes. If this is the case, we will work with you to bring you materials that you are able to access.): *YesNoPlease list some of your favourite books and/or authors: *What else can you tell us about what you would like to read? (For example, setting, theme, genre, non-fction topic, short stories, true stories, light reads, etc.) *How many items are you hoping we will deliver to you each month? *1-33-55-1010-12OtherIf you selected "other" above, please elaborate (optional):Any other comments about your interests or preferences?Electronic Signature *By typing my name above, I understand that I will receive about two calls a month from a volunteer, one to discuss loans, requests, and renewals and another call to schedule the drop-off and pick-up of materials to be returned. I am responsible for the materials signed out on my account and agree that the volunteer may access my account for the purpose of searching, placing holds, and renewing materials on my behalf. I agree to share my phone number, address, email, and library account information, with a trained Visiting Library Service volunteer. I agree to allow the volunteer to undertake catalogue searches and place holds on my behalf, as well as deliver library materials to me at home. I agree to allow the volunteer to see my “borrowing history,” if it has previously been enabled, or to enable online “borrowing history” on my account to facilitate in delivering new library materials to me. Volunteers are trained and have signed confdential policy and privacy documentation. Date (dd/mm/yyyy) *Submit
