Application for Residential Services

Application for Residential Services


Emergency Contact Information


Contact Information for Person Completing Form if not the Member


I grant Medina County District Library permission to keep a printed record/list of my borrowed items, requests and preferences for the purposes of selecting materials. This information will be used only by the Outreach Services staff to aid in selection of materials. The staff maintains the privacy and confidentiality of every library member.

Please note that it is not required to sign this waiver to receive library services.

Additional Questions Only for Staff or Volunteer Deliveries