The City of Liberty Lake, WA

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Home-Bound Registration

Use this form to register for Home-Bound delivery of items from Liberty Lake Municipal Library. At this time, only those living within the 99019 and 99016 zip code areas are eligible for once a month home delivery.

Questions marked with a (*) are required

1.	First & Last Name *
2.	Street Address *
3.	Apartment Number
4.	Zip code *
5.	Telephone Number:
6.	Email address (if you have one):
7.	Is a friend or relative filling out this form for you? * Yes No
8.	If you are filling this out for a friend or relative, please enter your name and telephone number to validate this request.
9.	Would you prefer Large Print Books? * Yes No
10.	You may have up to 5 books, 2 movies and 2 audiobooks delivered each month. Is this the right amount for you? * Yes No
11.	If 5 books are too many, please choose the correct number below:
12.	If 2 movies are too many, please choose the correct number below:
13.	If 2 audio books are too many, please choose the correct number below:
14.	The kind of story I enjoy most is:
15.	My second favorite kind of stories are:
16.	Non-fiction topics I enjoy are:
17.	I have and can use a DVD player * Yes No
18.	I have and can use a CD player * Yes No
19.	Other topics or stories I enjoy are:
20.	I have a home computer and can browse the Library's website to request the items I want delivered. * Yes No
21.	Do you agree to pay all costs and fees assesssed by the Library for lost or damaged materials? Overdue, lost or damaged books will result in loss of service and fees. * Yes No
22.	Please give us a name and phone number of someone we may contact for times you cannot answer your phone

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