2. Homebound Delivery Service is available

   for free home delivery of materials for Grapevine Residents who are unable to visit the library, either temporarily or permanently.

4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
15. Email
17. Phone Number
19. What is the best way to contact you?

    1. Phone
    2. Email
21. Grapevine Library Card Number
22. I do not have card.

    1. Help me get my library card.
24. By requesting this service: I give my permission for Grapevine Public Library staff to use my library card to check out materials for me. I also acknowledge that I am responsible for materials checked delivered to me through the Homebound Delivery Service. Do you agree?

    1. Yes

    1. No
26. Acknowledgement of Program Eligibilty

    1. I confirm that I am unable to visit the library in-person due to either limited mobility or disability.
28. Formats/Types of Materials

    Check all that apply.

    1. Large Print Books
    2. Regular Print Books
    3. DVDs
    4. BluRay (very limited selection)

    1. Audiobooks on CD
    2. Audiobooks on Playaway (limited selection)
    3. Music CDs
30. Areas of Interest
32. Nonfiction

    Check all that apply.

    1. Biographies/Memoirs
    2. Current Events
    3. Health
    4. History
    5. Philosophy
    6. Religion

    1. Science
    2. Social Science
    3. Sports
    4. Travel
    5. Other
34. If you selected other, please specify:
36. Fiction

    Check all that apply.

    1. Action & Adventure
    2. Best Sellers
    3. Christian
    4. Fairy Tales & Folklore
    5. Fantasy
    6. Historical Fiction
    7. Horror
    8. Humor
    9. Literary Fiction/ Classic Literature

    1. Mystery
    2. Poetry
    3. Realistic Fiction
    4. Romance
    5. Science Fiction
    6. Short Stories
    7. Sports Fiction
    8. Westerns
    9. Other
38. If you selected other, please specify:
40. Tell us about a few of your favorite books or authors. What do you like about them?
42. Is there anything else we should know about your preferences? (For example, authors you want to read, your particular interests, pet peeves, personal sensitivities, content restrictions, etc.)
44. Any other notes, comments, or suggestions?
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

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