Registration Form - - - Unbound Library: In-home Library Service

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Full name: *

Phone number *

Not required

Preferred contact method *

Phone

Address: *

I understand that this service is for Speedway Public Library patrons only and that I must live within the boundaries of the town of Speedway to get a library card and to use SPL's homebound service. *

Yes

I already have a library card with Speedway Public Library: *

Yes

I would like assistance getting a library card with Speedway Public Library:

Yes

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Emergency Contact Name & Phone Number: *If you do not answer your door for a scheduled visit after three knocks/doorbells and one phone call, your emergency contact will be notified. If no emergency contact is listed, the default contact becomes the Speedway Police Department for a welfare check. Type NA if you do not have an emergency contact. *

By applying for this service: I affirm that I am homebound and unable to visit the library due to a physical mobility issue or other disability. I give permission for Speedway Public Library to use my library card number to check out materials for me. I acknowledge that I am responsible for materials delivered to me through the Homebound Service. I may end this service at any time by contacting the Library. *

Yes

No - If you do not accept these terms, you may close this page to cancel registration.

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