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Henderson County North Carolina

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Homebound Services Application

Please fill out the form below to apply for homebound services. If you prefer to print and mail in a paper form, there is a link here. Someone will call you to discuss your eligibility and scheduling of services.

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Full Name *

Preferred Name

Your Phone Number *

Birthdate *

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Your Email Address

Facility Name (if applicable)

Street Address *

City, State *

Zip Code *

Emergency Contact Name

Emergency Contact Phone

Is your Emergency Contact authorized to receive information about your library account?

Yes

No

Did you know the library has resources available online? Would you like to learn more?

Yes

No

I am unable to come to the library due to temporary or long-term health, mobility, or disability barriers. *

Yes

No

I understand that I am responsible for all materials checked out on my account and that I will be charged the replacement cost for any materials that are lost or damaged. *

Yes

Digital signature (type your name to indicate that you agree to this application) *

Date of Application *

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I would like this many books each month

Book Format Preference

Large Print

Regular Print

No Preference for Large or Regular Print

CD Audiobooks

Genre Preferences for Books - FICTION

Christian

Classics

Fantasy

Historical

Horror

Literary Fiction

Mystery

Romance

Science Fiction

Thrillers

Western

Women's

Other

Genre Preferences for Books - NON-FICTION

Biography

Cookbooks

Crafts

Gardening

History

Humor

Memoir

Self-Help

Religion

Science

Technology

Other

My favorite subjects are:

My favorite authors are:

I really don't like:

Music Preferences

I would like this many music CDs each month

Movie Preferences

I would like this many DVDs each month

Music Genre Preferences

Blues/R&B

Broadway

Christian

Classical

Country

Rock

Movie Genre Preferences

Classics

Comedy

Drama

Musicals

Romance

Scary

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