Book Delivery Program

2. Enter the information for the primary library user here:
4. I am interested in:*

   1. Home Delivery

   1. Books-on-the-Go
6. Name*
8. Address
10. City
11. State
12. Zip Code
14. Phone Number*
15. Library Card Number
17. Email Address*
18. The best way to contact me is:*

    1. By Email
    2. By Phone
20. Emergency Contact
22. Name
23. Relationship
25. Emergency Contact's Phone Number
26. Emergency contact's email address:
28. Is your emergency contact authorized to receive information about your library account if needed?*

    1. Yes
    2. No
30. Acknowledgement of home delivery eligibility:

    Individuals who live in the Town of Clayton and Town of Clayton ETJ, are library cardholders in good standing, and are unable to get to the library because of age, disability, or illness.

32. Please check all that apply to you.

    1. I live in the Town of Clayton or the Clayton ETJ.
    2. I am a cardholder in good standing.
    3. I do not have a Clayton library card.
    4. I am unable to get to the library because of an age-related / illness / disability reason.
    5. Other
34. Other

    If you selected other please provide more information.

36. Check the box that most closely explains your selection abilities:*

    1. I am able to use the library's online catalog to select materials and put materials on hold.
    2. I would like to receive training to learn how to use the library's catalog to select materials and put the on hold. I have a computer or tablet.
    3. I do not feel comfortable using the online catalog and will need staff assistance to choose books and place holds.
38. Indicate your preferred format (check all that apply).*

    1. Physical Book
    2. Large Print Book
    3. Book on CD
    4. e-Book
    5. e-Audiobook
    6. Other
40. Other

    If you selected other please provide more information.

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field