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Mercer County Imagination Library Official Registration Form
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Child's full name
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Your answer
Birth date mo/da/yr
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DD
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YYYY
Sex:
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Male
Female
Phone number
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Your answer
2nd Preschool Child's FULL name:
Your answer
2nd Child's Date of Birth:
MM
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DD
/
YYYY
2nd Child's Sex:
Male
Female
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Parent name
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Your answer
Child's street address
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Your answer
City
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Your answer
zip code
*
Your answer
email address
*
Your answer
I hereby explicitly consent to allow the Dollywood Foundation, Inc. to use the information provided herein for the purposes of participating in Dolly Parton's Imagination Library book gifting program. To measure the benefits of this program we may create datasets with the information provided herein and share them with research and educational advancement partners. You agree to review our full Terms & Conditions and Privacy Policy by visiting
imaginationlibrary.com
. By submitting this form you expressly consent to the terms set forth herein.
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Yes
Please confirm your residence is in at least one of the following areas:
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Jamestown Area School District
Mercer County, PA
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