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Homebound Delivery Service Application

Fill out the form and click on Submit to apply for the Homebound Delivery Service from the Des Plaines Public Library. This service serves residents of the City of Des Plaines who are homebound.

Last Name:
First Name:
Address:
City: 
State, Zip:  
Phone:    e.g. 847.827.5551

Library Card Number:   

Health Condition that makes Homebound Delivery Service necessary:

Neighbor, friend or next of kin:
Name 
Phone e.g. 847.827.5551

Check the types of materials you would like and enter in the approximate quantity of each item you would like delivered each month. 

Qty/Month Qty/Month
Regular Print Large Print
Framed Prints Audio Cassettes
Compact Discs Audiobooks
(books on tape)

List your favorite authors and performers of music.

Check your Fiction preferences.

Bestsellers Classics Family Stories
Fantasy Historical Humor
Mysteries Plays Poetry
Romance Science Fiction Short Stories
Spy Stories War Stories Westerns

Check your Nonfiction preferences

Animals/Pets Antiques Art
Bestsellers Biography Computers
Consumer Info. Cooking Crafts
Current Events Gardening Health
History How-to Inspirational
Movies/Theater Music Politics
Psychology/
     Self-help
Religion Science
Sports Travel

List any other preferences

By applying for this service, I give my permission for Des Plaines Public Library personnel to use my library card to check out materials for me.

        

 

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