JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
MCPL Summer Reading Program Record
For every ten hours read, you will receive a chance to win a raffle prize!
Please enter the following information and click "Submit" at the bottom of this form:
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name:
*
Your answer
Last Name:
*
Your answer
Age:
*
Your answer
Phone Number:
*
Please include the area code. (ex. 219-873-3044)
Your answer
Email:
(optional)
Your answer
Number of Hours Read:
*
Choose
10
Raffle Prizes:
*
Select one prize to enter for a chance to win in the SRP raffle!
Cooau Action Camera (CU-SPC06)
Apple AirPods w/ Charging Case
Echo Dot Kids Edition
Echo Dot
Echo Show (8" Display)
Kindle Kids Edition
Kindle Fire 7 (32GB)
VTECH Touch & Learn Activity Desk Deluxe
Your Pet Robot Toy
Wild Animals Sound Book
Snap Circuits
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Michigan City Public Library.
Report Abuse
Forms
