Before Beginning Library Card Application * This application is intended for first-time Coastline library cardholders. If you have previously had a Coastline library card, please contact the library at (541) 269-1101 for assistance. I have not previously had a Coastline library card. First Name * Middle Name Last Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Phone Number * Street / P.O. Box * City * State * Zip Code * Driver's License Number (including issuing state) * Email Address Street Address (if different from mailing address above) Parent/Guardian Name (if under 18 years old) Parent/Guardian Address Parent/Guardian Phone Notice Type * - Select -EmailMailNone Library Card Agreement * Your card must be presented to check out materials. Your card is valid at all Coos/Curry County Public Libraries and the Southwestern Oregon Community College Library. Materials can be returned to any Coos/Curry County Public Library and the Southwestern Oregon Community College Library. Materials may be checked out by cardholder only. Card is NOT transferable. Any library can inform you of items checked out on your card. Your record is also viewable online at www.cooslibraries.org. Video material check out times are 7 days from the day they are checked out. Most other items are due 3 weeks from the day they are checked out. Coastline Libraries protect the confidentiality of library patron records under Oregon State Law, ORS 192.502.22. Library patron records are updated annually. Report lost or stolen cards immediately to protect your account. A fee of $1.00 will be incurred by the holder for card replacement. UNDER OREGON LAW PARENTS CAN BE HELD RESPONSIBLE FOR OVERDUE OR LOST ITEMS, AND FINES OR FEES ASSOCIATED WITH A CARD ISSUED TO A MINOR. *Patron understands that email notification replaces print/mailed notices, and correspondence concerning fines, overdue materials, hold notices, etc. will only be sent to the email address provided. I agree to the terms and conditions listed above. Cardholder's Electronic Signature * Today's Date * Month MonthDec Day Day8 Year Year2021