Persons with Disabilities Status Application Form

Name*

First NameLast Name

Chosen name

Library card number (14 digits)*

I prefer to be contacted by:*

Phone numberEmail

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Please confirm:*

I am eligible for Persons with Disabilities Status

Collection Notice: The Personal information on this form is collected under the authority of the Public Libraries Act, sections 20(a), (c) and (d). This information will only be used to administer and manage the selected service at the Library. Questions related to the collection of this personal information should be directed to: Senior Manager, Membership and Circulation Services, membershipservices@tpl.ca, (416) 395-5620.