Registration for Children in zip codes 15834, 15832 and 15861

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FREE - NO INCOME RESTRICTIONS TO SIGN UP - Any parent in Cameron County may register your child ages Birth to 5, to receive 1 free book every month from the Dolly Parton Imagination Library. Hometown Mentors, Inc. of Emporium, PA is a DPIL Champion and we are proud to bring this valuable program into our hometown, Cameron County.

This is a totally FREE gift to your baby and is funded this year by the Cameron County Commissioners, via funds to HMI.

Use this form to sign your babies up for a gift from Dolly. Their books will come in the mail with their name and address which will make them feel so special.

You may also receive emails from CathySwarmer@hometownmentors.org - with updates so please add this address to your contacts. Be assured that HMI will never sell your information and your information is secure.

Again, there is NEVER any cost to the parents and NO CREDIT CARD INFORMATION is required. The books are a gift from the Dolly Parton Foundation.

If you have any questions, please email us at cathyswarmer@hometownmentors.org

Parent's name, email and phone are required

Email *

Parents Full Name *

Parent's email address *

Parent's Phone Number *

FIRST Child's Full Name *

FIRST Child's Birthdate *

YYYY

Child's Gender

Male

Female

Prefer not to say

Clear selection

SECOND Child's Full Name

SECOND Child's Birthdate

YYYY

Child's Gender

Male

Female

Prefer not to say

Clear selection

THIRD Child's Full Name

THIRD Child's Birthdate

YYYY

Child's Gender

Male

Female

Prefer not to say

Clear selection

Child (children's) full mailing address *

A copy of your responses will be emailed to the address you provided.

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