UCPL Summer Reading Registration Form

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Our Summer Reading program will run from June 15 - July 31 for ages 0-18! Please fill out both parts of this form. The first page is registration info and the second page is a very short "All About Me" activity for your child.

Child's Name (First and Last) *

Please Select One: *

Boy

Girl

Prefer not to say

Age: *

School attending in the fall *

Grade child is entering in the fall: *

Do you give permission for Union Co. Public Library District to submit your child's name and/or picture to the media for promotion of the library? *

YES

Do you want your child to be eligible to win prizes from Union Co. Public Library District? *

YES

Parent/Guardian Name: *

Relationship to child: *

Phone number that we may contact you at:

Please read the statement below: *

I understand that if I choose not to provide a contact phone number my child will not be eligible for any prize giveaways.

Required

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