Mailbox Books Application


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Application for Mailbox Books Service for the Homebound
Forsyth County Public Library
2820 Old Atlanta Road
Cumming, GA 30041
(770) 781-9840


Applicant Information
Name *
  LAST FIRST MIDDLE INITIAL
Address *
  STREET ADDRESS CITY/STATE/ZIP
Telephone Number *
Numbers only Ex.1234005000
Email Address Birth Date
Do you have a library card? Card Number
Do you give permission for the library to keep a record of the materials sent to you?
(If you wish the staff to select materials for you and to avoid duplication, this is necessary.)
Do you require books in large print or on audio?
(If yes, please complete the Verification of Application for Large Type Books.)


Alternate Contact
Name
  LAST FIRST MIDDLE INITIAL
Telephone Number
Numbers only Ex.1234005000
Email Address


Statement of Eligibility
I am a cardholder of Forsyth County Public Library and am homebound because of:
  • AGE, which is
  • CHRONIC ILLNESS, which is
  • VISUAL IMPAIRMENT, which is
  • PHYSICAL DISABILITY, which is
  • OTHER (please specify):

I understand that I am responsible for any damage or loss of material. If the applicant is under 18, a parent or guardian must also sign indicating willingness to accept responsibility.

* By checking this box, I indicate that I agree to the above terms.


Book Selection Information

The staff will send specific titles you request, if available, or can choose books and other materials for you. If you wish to have books selected for you, the library needs information about your reading interests. Please check below the types of books/materials you prefer:

Books:


Other:

Large print/audio users will be sent materials under the U.S. Postal Service's "Free Matter for the Blind and Handicapped" program. No postage is required in mailing the library's large print books or audio cassettes.

Preferred Authors:
Preferred Artists:

Check as many of these categories/interests as you wish:

Nonfiction Fiction




















Other:

The Forsyth County Public Library promotes accessible library services to all persons and does not discriminate on the basis of race, religion, color, sex, age, national origin or disability.

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