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Sampson-Clinton Public Library System
Summer Reading Program 2020: Imagine a Story Registration
*Please note that one form must be completed per child being registered
*Registration will close Friday, June 12th.
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Full Name of Individual Completing the Form
*
Your answer
Email Address
*
Your answer
Mailing Address
*
Your answer
Phone Number
*
Your answer
Relationship to Child
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Parent
Grandparent
Required
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
School your child will be attending in Fall 2020
*
Your answer
Grade Level Child will be entering in Fall 2020
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
Reading Challenge Goal- Please write the # of books you wish to read. Please note once you submit this form the goal number cannot be changed.
*
Your answer
How did you hear about our program?
*
Website
Friend
Newspaper
Advertisement
School System
Other:
Comments and/or questions
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