Home Library Service Application Form

Are you completing this form on behalf of the applicant?

Yes

Carer's details

Name

Organisation (if applicable, e.g. aged care facility)

Phone

Applicant's details

Name

Phone

Date of birth

Email address

Confirm email

Language - other than English

Sex

Male

Female

Prefer not to say

Next of kin/emergency contact

Relationship

Phone number

Second Next of kin/emergency contact

One of the emergency contacts must live locally

Relationship

Phone number

Street address

Suburb

State

Postal code

Additional information for ease of delivery

Please provide any instructions or additional information to assist our courier e.g. visitor parking available, security building, type of building (dual accommodation, duplex, ground floor granny flat), etc.

How did you hear about our home library service?

I give permission for Home Library Service staff and volunteers to enter my premises/room

I have read and accepted the terms of service.

Terms and conditions of the Home Library Service membership

Home Library Service membership is conditional upon agreeing to our terms and conditions.

Members will:

accept responsibility for all items borrowed on their card
have items ready for collection by our library staff or volunteer on or before the due date
avoid overdue items by contacting the library to renew loans if permissible
advise the library of any changes to their contact details including delivery address
advise the library of any changes to their circumstances affecting delivery, e.g. absence due to holidays, illness, etc.
pay replacement costs for any items lost or damaged

In the unfortunate event that a member breaches these membership conditions, the library reserves the right to restrict or ban access to library materials or terminate library membership.

These conditions of membership are subject to change without notice.

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