Summer Library Program Registration 2023

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REGISTRATION GUIDELINES:
1) All programs are FREE!
2) Each participant must be registered separately
3) Each participant may only register ONCE
4) While all participants are welcome to attend any and all programs they wish, the specific library and age group designated on the registration form determines the grand prize drawing into which the participant will be entered
5) Please also register (only once) each parent/guardian that may be present at programs

Participant or Parent/Guardian *

Participant

Parent/Guardian

Choose 1

Library *

Lumberton

Oak Grove

Purvis

Sumrall

Choose 1

Program *

Early Literacy (0 to 4 years)

Children (5 to 10 years)

Teen (11 to 18 years)

Adult (18 and up)

Choose 1

Last Name *

First Name *

Address *

Please include street, city, state, and zip on one line.

Phone Number *

Enter a phone number where the parent or guardian can be reached. Include area code. Ex: XXX-XXX-XXXX

Parent or Guardian's Name

Required for participants under age 18

Email Address

Email address where parent or guardian (or adult participant) may be reached.

Age *

< 1 to 4

5 - 10

11 - 18

18 +

Grade Entering (If you are an Adult, please answer with N/A). *

Grade that participant will be going into after summer break.

Publicity Disclaimer *

The library always takes photographs and videos of participants in all library programs and many of these photographs/videos are used on our website and social media pages and in other publicity. If you do not wish your child's image to appear online or in other publicity materials, it is your responsibility to inform a staff member. If you happen to see your child's image online, please let us know and it will be taken down immediately.

I have read and understand the publicity disclaimer.

Hold Harmless Statement - Agreement Required *

I hereby release Lamar County Library System, its employees and agents from any injury or damage I or my child may suffer as a result of our voluntary participation in this activity and I hereby hold harmless Lamar County Library System, its employees and agents from any and all liability as a result of any injury or damage, of whatever nature, I or my child may suffer as a result of our voluntary participation in this activity.

I agree

Do you have any food allergies? If so, please list them. *

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