Outreach Services Home Delivery Application At the Greene County Public Library, we serve all residents – even when you are unable to visit us in-person! You never have to miss out on library resources and fun – your Outreach librarian will bring them to you! Our dedicated staff will deliver your requests – or handpick items based on your interests – all right to your door. All you have to do is sign up! * indicates a required field Caregiver I am filling out this application for someone else Caregiver name First Last Caregiver phoneEligibility * RequiredYou are homebound due to (check all that apply) physical disability illness age 1. Tell Us About YouName * Required First Last Birth date - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Address * Required Street Address City State / Province / Region ZIP / Postal Code Email Address * Required Telephone * RequiredEmergency contact name First Last Emergency contact phoneClick the Next button below to let us know your interests. Next 2. Let Us Know Your FavoritesRequesting specific titles and filling out the survey below will help us to pick out items just for you!How many books would you like each month?Book format regular print large print books on CD Favorite authorsFICTION Crime Fantasy Romance Science Fiction Horror Western Inspirational Historical Fiction Religion • Spirituality NotesNON-FICTION True Crime Politics Self-Help Travel Educational Art • Crafting Biography • Autobiography • Memoirs Religion • Spirituality • Philosophy NotesDVDs I am interested in receiving TV Shows and Movies of the genres indicated above NotesHow many DVDs would you like each month?MAGAZINES I am interested in receiving Magazines of the genres indicated above NotesHow many Magazines would you like each month?MUSIC Rock • Pop Jazz Blues • Folk World Christian • Spiritual Opera • Classical Country • Bluegrass NotesHow many CDs would you like each month?3. Start Getting Library Items TodayTo complete the form, press SUBMIT below. Need further assistance? Contact your Outreach librarian at 937-736-7073.EmailThis field is for validation purposes and should be left unchanged. Previous Close Can you tell me more about this webform submission? The contents of this webform are sent to library staff via email. We recommend that you do not submit confidential information (like your library card number, passwords or credit card information). If you need to share confidential information with library staff, we suggest that you use other channels of communication, such as the telephone.Visit our Privacy Statement, opens in a new window, opens a new window to learn more about how your personal information is handled and protected. This information will be submitted via email. Learn More about sending data over email.