Summer Reading Registration Form

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Child's Name

Address

Phone Number

Age

Grade in Fall 2022

I hereby give my consent for the Arkansas River Valley Regional Library System to use my photograph and likeness to be used in its promotional materials and publicity efforts. I understand that the photograph(s) may be used in a publication, social media, or on its website. I also acknowledge the Library's right to crop or treat the photography at its discretion. I release the Arkansas River Valley Library System, its Board of Trustees, all employees and the photographer from any expectation of confidentiality and for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below.

Yes, photos may be used.

No, photos may not be used.

Clear selection

Electronic Signature for the use of photographs. (please type your full name)

Date of Signature

Names of Minor Children

Submit

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