You must have JavaScript enabled to use this form. House Calls Patron Information Name * Address * City/Zip * Birth Date Year Year19241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Library Card Number 2147700 last 7 barcode digits Phone * ( Area code ) Exchange - Number Email I am a resident of Monroe County who is unable to use the Monroe County Public Library system because: (Choose one) House Calls use I have a physical disability or chronic illness resulting in a loss of mobility. I am convalescing from surgery or illness. I am a caregiver for a person with one of the above limitations. Keep Record By checking this box, I give permission for Monroe County Public Library to keep a record of the library materials sent to me in order to avoid duplication. This information is kept confdential within the Library. Emergency Contact Name * Phone * ( Area code ) Exchange - Number Please check all that apply Books I have trouble holding large or heavy books I am interested in downloading free Library eBooks and/or Audiobooks I prefer LARGE PRINT books I prefer paperback books Number of BOOKS I would like to receive per month. - None -1-23-56-1011-20more Number of PLAYAWAY AUDIOBOOKS I would like to receive per month. - None -1-23-56-10more Number of AUDIOBOOKS ON CD I would like to receive per month. - None -1-23-56-1011-20more Number of MOVIES ON DVD I would like to receive per month. - None -1-23-56-89-14 What types of movies? Number of MUSIC CDs I would like to receive per month. - None -1-23-56-1011-21 What types of music? Number of MAGAZINES I would like to receive per month. - None -1-23-56-10more What types or titles of magazines? Please check your favorite reading categories. FICTION / STORIES Best Sellers Mystery (cozy/mild) Mystery (thrillers/police) Historical Fiction Science Fiction/Fantasy Jewish Authors African American Authors Indiana Authors Romance (mild) Romance (wild) Classics Animal Stories Hispanic Authors Amish Christian Inspirational Westerns Humor Occult/Horror Short Stories Other: FICTION / STORIES Other: NONFICTION / INFORMATION Biography Historical Biography Political Biography Hollywood Biography True Crime Music Poetry Psychology & Self-help Travel & Geography Indiana History History: (era & places) Religion Religion: Religion_more Nonfiction 4 Computers Cooking Fitness & Exercise Gardening Health & Medicine Nature & Animals Science & Technology Sports Arts, Crafts, & Hobbies: Kinds of crafts Nonfic Other Other: Other_more Please add any comments as well as favorite authors, movies, and music--anything that will help us choose materials of interest. Url Updated August 12, 2024 print this page
