Application for Accessibility Services

  • Current Part 1: Personal Information
  • Part 2: Delivery Service
  • Part 3: Eligibility for Accessible Formats
  • Part 4: Equipment
  • Part 5: Reading Profile
  • Complete
Nature of Disability/Reason for Service
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 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 severe or total impairment of hearing
I am a senior without transportation
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.
For children under 12 or an incapable minor under 19, a parent’s or guardian’s signature is also required

Please sign below.