Homebound program application

WATERFORD PUBLIC LIBRARY 
49 Rope Ferry Road 
Waterford, CT 06385 
860-444-5805 
 
APPLICATION FOR HOMEBOUND LIBRARY SERVICE 
 
In keeping with its mission of helping the citizens of Waterford enrich their lives 
through access to ideas, information, and entertainment, the Waterford Public 
Library offers delivery and pickup of library materials to homebound Waterford 
residents.  
 
The Library is pleased to partner with Thames Valley Council for Community 
Action, Inc. /Retired & Senior Volunteer Program.  TVCCA/RSVP volunteers will 
provide the delivery and pick-up services for the Library. 
 
Date of application: 
 
______________    
 
 
 
 
Name: 
 
 
 
______________________________________ 
Address: 
 
 
 
______________________________________ 
 
 
 
 
 
______________________________________ 
Telephone:  
 
        ________________ 
 
I have read and attest to my eligibility to participate and agree to abide by the 
library guidelines and rules governing homebound library service as set forth on 
the reverse side of this application. 
 
Signature: _____________________________  
Date: ______________ 
___________________________________________________________________ 
FOR LIBRARY USE ONLY: 
WPL library card  
 
 
Yes 
 
New issued 
Library questionnaire completed: 
Yes 
 
No 
Approved/To TVCCA: 
 
 
Yes 
 
No 
 
Director/designee:  
____________________  
Date: ____________ 
 
TVCCA approval date: 
____________________ 
 
Service start date:  
____________________ 
 

 
WATERFORD PUBLIC LIBRARY 
Homebound Library Service 
 
• ‘Homebound’ is defined as an individual who, because of a physical or 
mental disability or long-term illness, is unable to visit the Library, and does 
not have anyone who can pick up/deliver materials to her/him on a regular 
basis. 
• Participants must live in Waterford or Quaker Hill and have a valid 
Waterford Public Library card.  New library card application enclosed. 
• While enrolled in the program the participant’s library card will be kept at 
the library. 
• Participants must complete a telephone interview with TVCCA staff, agree 
to an initial home visit from TVCCA and meet all TVCCA requirements. 
• Participants will complete the library questionnaire about interests.  
• Participants agree to allow the library to maintain records of borrowed 
materials. 
• Maximum of 10 items in total per delivery: 
o May include books, magazines, music CDs, audio books and up to 5 
movies (due to limited collection).  
o Current bestsellers and other items in high demand may not be 
available. 
o Specific titles may be requested through library staff. 
• All items must be available at the Waterford Public Library. 
• Pick-up/delivery will be scheduled as staffing permits but at least once per 
month. 
• Overdue fines will not be charged but established fees will be charged for 
lost or damaged items. 
• Items will be delivered, and must be returned, in library-provided bag. 
• When new materials are delivered, items from the previous delivery must 
be ready for return. 
• The Library may terminate service to any individual who fails to meet the 
eligibility requirements or misuses the service. 
• The Library reserves the right to amend, modify, add or delete any of the 
terms of this service without prior notice. 
 
10/2019