Mamaroneck Public Library

Homebound Application

Fields marked with an * are required

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From our library to you.

Books and more

@ your door!

First Name *

Last Name *

Date *

Address *

Apt #

Country *

City *

Zip *

Phone *

Preferred time to contact? (if any)

Email (if applicable)

Reason for Requesting Service *

Is this temporary or permanent? *

Temporary
Permanent
Unsure

The library respects the privacy and confidentiality of all patron records. In order to provide excellent service and avoid duplication of materials, may we have your permission to keep a record of these items? If yes, please sign below.

Signature (Parent / Guardian if applicant is under age 14) *