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Homebound Delivery Policies

Please read the Homebound Delivery Policy brochure in its entirety before completing this form.
Homebound Delivery Policies
I have read the policy brochure, and am ready to continue.*
1. Agree
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Applicant Information

Applicant's First Name*
Applicant's Last Name
Applicant Contact*
Email or Phone Number
Reference For Homebound Eligibility
Suggested references include your physician, nurse, social worker, or member of the clergy. Anyone who has qualified for community services like Meals on Wheels will automatically be eligible for Homebound Delivery.
Reference Contact
Email or Phone Number
Do you have a library card?*
1. Yes
2. No
If you do not already have a library card with us, you will be asked to create one as part of our signup process.
Library Card Number*
Please select your reason for applying for Homebound Delivery*
1. Physical disability
2. Limited mobility
3. Recovery from surgery or injury
4. Other hardship
Release & Service Agreement
By reading and signing below, I agree to the conditions set by Iredell County Public Library for use of Homebound delivery, and release its representatives from any claims of loss associated with this service. In addition, I agree to the following:
1. I will be held responsible for any materials that are lost or damaged in my home.
2. Deliveries will be scheduled and fulfilled at the library’s discretion.
3. The library representative will be responsible solely for making deliveries and help selecting materials. They will not be available for assistance with any other daily living activities or personal matters.
4. I verify that the information filled out on this form is accurate, to the best of my knowledge.
5. I have read the Homebound Services policy brochure in its entirety, and understand and agree to all conditions outlined therein. This includes qualifications for this service, as well as home safety guidelines to be met as a condition for each delivery. I understand that failure to abide by these guidelines may result in loss of services.
Applicant's Electronic Signature*
Date*
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