Summer Reading 2020 Registration Form

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Summer Reading Registration

Participant's First & Last Name (One participant per registration - please complete an additional registration "form" for each additional participant - thanks!) *

Street Address *

City, State, Zip *

Grade going into this fall *

Emergency Contact Info for Minors-First & Last Name & Phone # (if registering an adult, indicate N/A) *

Permission for minor's name/likeness to be used in media (no compensation is offered for use of likeness) *

I GIVE permission for my name/likeness (if adult) or this minor's name/likeness to be used in the newspaper, social media, etc.

I DO NOT GIVE permission for my name/likeness (if adult) or this minor's name/likeness to be used in the newspaper, social media, etc.

By entering my name below, I agree that I am registering myself or a minor child for whom I am responsible in the Valley Center Public Library Summer Reading Program. *

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