Form Center

2. 
4. Welcome!

   Looking for something new for movie night? Sign up for our Video Valet subscription service at RCPL. Participants in the program will receive a curated movie pack each month.

6. Name:*
7. Library Card Number:*
9. Email Address:
10. Phone Number:
12. Library Pickup Location*
    -- Select One --Bent MountainGlenvarHollinsMt. PleasantSouth CountyVinton

    Video Valet packs can only be picked up at a Roanoke County Public Library.

13. Age*

    1. Teen
    2. Adult
14. For Current Subscribers:

    1. Cancel My Subscription
16. What rated films would you like?*

    1. G
    2. PG
    3. PG-13
    4. R
    5. NR/TVMA
17. Film Type:*

    1. DVD
    2. BluRay
18. How Many Movies a Month?*

    1. 1
    2. 2
    3. 3
    4. 4
    5. 5
    6. 6
20. Do you want one of your titles to be a wildcard?

    Something outside of your usual genre preferences.

    1. Yes
    2. No
21. Would you be interested in a TV series to watch?

    1. Yes
    2. No
23. What are some of your favorite movies? What do you like about them?*
25. What makes a movie "good" for you?
27. What are some movies that you would not want to watch again?
29. Genres:
    Fill out the survey below to help us select titles for you.
31. Comedy

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
32. Romance

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
33. Thriller

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
34. Drama

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
36. Horror

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
37. Action

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
38. Documentary

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
39. Classics

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
41. Foreign Language

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
42. SciFi/Fantasy

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
43. Independent

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
44. Historical

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
46. Animation

    1. Often
    2. Sometimes
    3. Rarely
    4. Never
47. Other:
    Fill in the blank with other topics. Separate with a comma.
49. Thank you!
    We will contact you when your subscription is available for pick up at RCPL.
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field