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Library Direct Home Service registration form
Library Direct Home Service registration form
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Data Protection
Please complete all fields marked
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DATA PROTECTION PRIVACY NOTICE
In accordance with the Data Protection Act 2018, I hereby give consent for Surrey Libraries to store and share my personal information securely with my volunteer. This is for service evaluation purposes and in case any issues arise regarding your library account. We will not share your data beyond your volunteer and partners as listed in our
Libraries Privacy Notice
without your permission.
Consent:
*
I agree
Your details
Title
*
Choose...
Mr
Mrs
Miss
Ms
other
If "other" please state
Surname
*
Forename(s)
*
Address
*
Postcode
*
Email (if applicable)
Contact telephone
*
Date of birth
*
Emergency contact information
Your wellbeing is important to us. We will telephone this person if your volunteer is concerned about your wellbeing. Please ensure you inform your contact that we will be holding their details as part of our Library Direct Service. If you are unable to give us an emergency contact and your volunteer is unable to contact you, to ensure you are safe and well, we may inform the Police or Adult Social Care.
Emergency contact name
Telephone/mobile number
Relationship to above
General information
Please briefly describe why you require this service
*
Is your need for the service permanent or due to a temporary condition?
*
Choose...
Permanent
Temporary (ie less than one year)
If you have preferred times and days for your volunteer visits, please note them here.
How would you like us to contact you?
*
Choose...
no preference
telephone
email
through emergency contact
How did you hear about this service?
*
Choose...
in Library
library website
word of mouth
local/county publication
other (eg a wellbeing advisor)
if "other" please state
To help us find the right volunteer for you, please tell us the following.
Would you prefer your volunteer to be female, male or have no preference?
*
Choose...
Female
Male
No preference
Do you live alone?
*
Choose...
Yes
No
If "no" please specify what your relationship is to that person(s).
Do you or others smoke in your home?
*
Choose...
Yes
No
Do you have any pets?
*
Choose...
Yes
No
If "yes", please give us details.
Please let us know the type of property your volunteer will be visiting.
*
Choose...
Flat
House
Sheltered housing
Care home
Other
If "other", please give details
Parking options available to your volunteer.
*
Choose...
Free off road parking
Free on road parking
Visitors car park
Permit parking
Public car park nearby
To help us get the right stock for you, please give us an idea of your reading preferences
Formats (select as many as you wish)
*
Books [standard print]
Books [large print]
Audiobooks on CD
Paperbacks
Hardbacks
Level (select as many as you wish)
*
Adult
Young adult
Junior
Fiction - styles (select as many as you wish)
Classics
Crime/Thriller/Adventure
Graphic novels
Historical/Saga
Humour
Romances
Science fiction/Fantasy/Horror
Short stories/Quick reads
War stories/Sea stories
Westerns
Non-fiction categories (select as many as you wish)
Animals/Pets
Art/Craft/Collecting
Biography
Economics/Politics
Entertainments (incl. music)
Food/Cookery
Health/Wellbeing
History (including local history)
House/Home/Gardening/Plant life
Mind, body and spirit
Poetry/Plays
Science/Technology
Sports
Transport
Travel (guides/stories)
True (crime/life stories)
Wars/Warfare
Other special interests and favourite authors:
If completing on behalf of someone else, please provide your name and a contact number:
Name
Relationship to above
Contact telephone number and/or email
Library Direct service guidelines
Please read our
Library Direct Home Service guidelines
.
Ignore this text box. It is used to detect spammers. If you enter anything into this text box, your message will not be sent.
If you have completed all the fields marked
*
, then please click "Submit".
Updated: 16 May 2022
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