Please email completed form to - Home - Libraries ACT



APPLICATION FOR HOME LIBRARY SERVICEORGANISATIONSThis form is to be filled out by a representative of an organisation, institution, or facility with residents that cannot access the library, and who would benefit from deliveries of library items. Examples of such an organisation include but are not limited to, nursing homes, mental health recovery units, addiction recovery centers, or emergency accommodation such as refuges.Please email completed form to HomeLibrary@.au or send via post to Home Library Service, GPO Box 158, Canberra City ACT 2601Responsible Person(s)Due to the nature of a library membership, it is required that at least one individual to assume personal responsibility for any items borrowed and to be a point of call for when the library may need to make contact regarding this membership. It is important to note that if only one person is indicated as responsible for the account, the registration is similar to that of an individual and registration may be suspended if that one person is no longer available. For this reason, it is recommended that you list multiple people here to ensure the longevity of the registration. Each nominated person must sign and agree to the terms and conditions listed below under (2). This list can also be updated at any time by contacting the Home Library Services Coordinator.At least one signatory must have financial delegation within your organisation – this is so the library can apply fees to the organisational account as necessary to comply with the library’s terms and conditions, with the expectation that the organisation can pay those fees. Please note that the signatory or signatories with financial delegation will be contacted by the Customer Information Centre and required to provide identification to complete registration.Full nameBest contact (phone number or email address)SignatureFinancial Delegation (Yes/no)Terms and ConditionsThe following terms and conditions apply to your membership. You are required to:Return library material by the due date or contact Home Library to renew rm the library of changes to your personal details and relevant personal circumstances.Pay for lost, damaged or stolen library materials plus any administrative fees.Be responsible for all items loaned out under your name.It is important that you know that:Your membership can be suspended if you have excessive overdue items or if items are returned damaged to the library.Any personal information that you give to the library will be kept strictly private.Library staff will access your record to check and edit details, loan or renew items, and request items on your behalf.A detailed copy of the Libraries ACT terms and conditions and privacy policy are available on the website: have read and agreed to the above terms and conditions.Signature 1: ............................................................................................ Date: ........................Signature 2: ............................................................................................ Date: ........................Signature 3: ............................................................................................ Date: ........................Signature 4: ............................................................................................ Date: ........................Signature 5: ............................................................................................ Date: ........................Organisation detailsFull name of organisation: ...............................................................................................................................................Phone number: …………………………………………………………………………………………………………………Email: .....................................................................................................................................Address (Optional, see (5)):……………………………………………………………….................................. ……………..................................................................................................................................Suburb: ............................................................................................... Postcode: .................Type of OrganisationPlease note that a requirement of access to the Home Library Service is an inability or great difficulty in being able to physically attend the library. For this reason, this type of membership must be filled by an organisation with residents that meet that criteria. If you are unsure of your eligibility, feel free to call the Home Library Service coordinator on 6207 5748.Nursing home or aged care facilityMental health recovery facilityEmergency accommodation (Refuge etc.)Outreach organisation (Visits housebound individuals, such as respite care)Addiction recovery organisationDisability care organisation (Outreach, home based, or residential)Other (Please specify): ……………………………………………………………………………………………Delivery PreferencesPlease note that you are not required to provide the address of your organisation if doing so would breach your own policies on security, such as for a refuge wherein residents require an undisclosed location. If this is the case, please arrange for a member of your organisation to attend the library to collect items.A member of the organisation can come to the library to collect items (please note that some deliveries may be large and require a vehicle larger than a standard car).Libraries ACT staff members will be required to deliver to the organisation.Reading PreferencesWe will take more detailed preference information from you during our visits.How many items would you like for us to select and send? Please note that we provide a maximum of 4 bags of material per delivery for facilities (approximately 36 items)................. Standard Print Books................ Large Print Books................ Magazines................ Audio Books................ DVD’s................ CD’sWhat type? – Fiction (please tick at least five)AustralianHumorousScience FictionAward winning authors Literary & ClassicsShort Stories Family & RelationshipMystery & Detective Thriller & SuspenseFantasy & Horror PlaysWesternsHistoricalRomanceOther (Please specify)What type? –Non Fiction (please tick)Arts & CultureHobbies & CraftsTravel (Places)Business & EconomicsHouse & GardenReligionCommunity & SocietyHistory & PhilosophyStyle & FashionEducationLanguagesScience & MathematicsFamily & RelationshipsNature & EnvironmentSports & RecreationFood & DrinkBiography (People)Transport & TechnologyGeneral InformationSelf Help (Personal Development)Other (Please specify)Health & MedicinePolitics & GovernmentWhat type? –DVD (please tick and specify genre above in tick boxes, or below on dotted line.)DocumentaryForeign FilmsChildren’s DVDFeature FilmsTV SeriesOther (Please specify)Do you have any other preferences? (e.g. favourite authors, other languages, other genres)........................................................................................................................................................................................................................................................Please send your completed application form to homelibrary@.au or Home Library Service, GPO Box 158, Canberra City ACT 2601 ................
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