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All Surrey Libraries branches will be closed Tuesday, July 1 for Canada Day.
Application for Accessibility Services
You must have JavaScript enabled to use this form.
Current
Part 1: Personal Information
Part 2: Delivery Service
Part 3: Eligibility for Accessible Formats
Part 4: Equipment
Part 5: Reading Profile
Complete
First Name
Last Name
Address
Address
Address 2
City/Town
Postal Code
Phone
Email
Date of Birth
Gender
- None -
Male
Female
Non-binary
Nature of Disability/Reason for Service
I have a learning disability such as a perceptual impairment
I have a learning disability such as a perceptual impairment
I have a physical disability such as the inability to hold or manipulate a book
I have a physical disability such as the inability to hold or manipulate a book
I have an impairment of sight, or inability to focus or move my eyes
I have an impairment of sight, or inability to focus or move my eyes
I have a mobility challenge such as an illness, injury or disability that prevents me from visiting the library, carrying library materials or leaving my home for an extended period
I have a mobility challenge such as an illness, injury or disability that prevents me from visiting the library, carrying library materials or leaving my home for an extended period
I have a severe or total impairment of hearing
I have a severe or total impairment of hearing
I am a senior without transportation
I am a senior without transportation
Secondary Contact
Phone
Relationship to Applicant
Email
Customer Authorization
I give Surrey Libraries permission to keep a list of books checked out to me in order to avoid receiving duplicates. I agree to be responsible for all materials delivered to me, and to abide by the rules and regulations of Surrey Libraries.
Please sign below.
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Parent/Guardian Signature
For children under 12 or an incapable minor under 19, a parent’s or guardian’s signature is also required
Please sign below.
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