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Summer Reading Program Registration
Complete this form for EACH CHILD please..you will need to come by the library
and pick up a packet for each child registered. If you need any further information,
please call (325)573-5572 and ask for Amy Hodges.
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* Indicates required question
Email
*
Your email
Child Last Name
*
Your answer
Child First Name
*
Your answer
Parents/Guardians First and Last Name
*
Your answer
Library Card Number (If under school age, please put parents card number) All participants must have a card to participate, you may come to library to obtain one. (2 proofs of address and an ID are required)
Your answer
Parent/Guardian Cell Phone Number
*
Your answer
Permission to receive Text Updates
*
Yes
No
Age of Child
*
Your answer
Current Grade Completed (put Pre-school if younger than school age)
*
Your answer
*
Male
Female
Required
Independent Reader (READING WITHOUT HELP)
*
Yes
No
T-Shirt Size (only if T-Shirt is given as a prize)
*
Your answer
Any Food Allergies?
*
Your answer
Any additional comments/information can be added here...
Your answer
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