Outreach Request

Outreach Services Application Form

Please submit this form to request outreach service.

Name(Required)

First Last

Date of Birth(Required)

MM/DD/YYYY

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

xxx-xxx-xxxx

I am a resident of Shrewsbury who is unable to use the library through regular means(Required)

[Type "Yes" or "No"]

I am a parent or guardian of a resident of Shrewsbury who is unable to use the library through regular means(Required)

[Type "Yes" or "No"]

Signature(Required)

Type your name here to electronically sign this form. Parents or guardians should sign for residents under 12.

I am interested in the following types of items (regular-size books, large-print books, DVDs, magazine, paperbacks, books on CD):

[Type your preferences]

Please list your favorite authors, series, or topics:

[Type your preferences]

Deliveries are provided on Tuesdays and Wednesdays.

If you have trouble filling out this form, our Outreach Librarian, Diana Karas, will be happy to assist you. You may contact her at dkaras@cwmars.org or 508-841-8535.