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HomeWord Bound Form
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HomeWord Bound
* Required
Qualification for HomeWord Bound Service:
I am a resident of Deschutes County, Oregon
At least one of these must apply:
*
Short-term disability
Long-term disability
Illness which confines individual to their home
75 years or older
If you qualify for HomeWord Bound services, please provide the following contact information:
Name
*
Mailing Address
*
City, State, Zip
*
Physical Address (if different)
Home Phone (so library staff can contact you)
*
Best day and time to call you
Email
*
Gender
Male
Female
Birth date
*
Do you reside in a residential care facility or an apartment complex?
yes
no
If "yes," facility name
Name of person helping fill out this form
Should library staff contact the person helping to fill out this form about applicant's reading preferences?
yes
no
If yes, phone number
*
By selecting this checkbox I understand and agree to the following statements: If I lose or damage an item I am responsible for the replacement cost. I understand I will be notified of overdue items on my account and will return them promptly. My library account and personal information will be kept on file at the Library. Staff and volunteers will access my account and use functions such as 'My Reading History' to manage my selections. I may become ineligible for the program if circumstances change or I am unable to abide by the guideslines set forth.
Page Last Modified Friday, October 16, 2020
Services
Ask a Librarian
Book-a-Librarian
Homebound Services
HomeWord Bound Form
Lawyer in the Library
Servicios Latinos
Obituary Requests
Educator & Student Services
Senior Services
Technology at the Library
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