Surrey County Council - Library Direct Home Service registration form

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DATA PROTECTION PRIVACY NOTICE

In accordance with the Data Protection Act 2018 and in order for us to provide you with a Library Direct volunteer we require your consent to store and share your personal information (including health information) with your volunteer. We will store your personal details securely for the duration of the time that you are being visited plus five additional years. 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 listed in our Libraries Privacy Notice without your specific permission. If you consent to this usage of your data please confirm your agreement by ticking the box.

I agree for my personal details, including health information, to be held as agreed and for this information to be shared with my volunteer. *

I agree

Your details

Title *

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? *

If you have preferred times and days for your volunteer visits, please note them here.

How would you like us to contact you? *

How did you hear about this service? *

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? *

Do you live alone? *

If "no" please specify what your relationship is to that person(s).

Do you or others smoke in your home? *

Do you have any pets? *

If "yes", please give us details.

Please let us know the type of property your volunteer will be visiting. *

If "other", please give details

Parking options available to your volunteer. *

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

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.

If you have completed all the fields marked *, then please click "Submit".

Library Direct Home Service registration form

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