Skip to form

Georgetown Township

1515 Baldwin St, PO Box 769, Jenison, MI, 49429-0769, US



This application for Homebound Delivery Services is to be filled out by the library patron, and requires certification from a physician, nurse, or social worker. Your physician, nurse, or social worker can be invited to sign via email when you finish your part of the application and click "Submit."

Your application will not be processed until it is certified.
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
Signature HereClick to Sign
02/29/2024Click to Sign
Signature HerePhysician/Nurse/Social Worker Will Sign Here

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.


Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue


Additional Signatures Required