Summer Reading Program 2022
Read Beyond the Beaten Path!
Events each Tuesday in June at Dike City Hall - June 7, 14, 21 and 28 at 10am
Lunch will be provided after each program by local church women's groups
Geared toward children entering Pre-K through 6th grade
Sign in to Google to save your progress. Learn more
Email *
Name of Child(ren) - OK to list multiple children of family on 1 form *
Age(s) of Child(ren) - if entering multiple children on form, please check all that apply
Grade(s) entering next year (program is for Pre-K through 6th grade - younger children are welcome to attend with siblings, etc., but program is geared toward Pre-K through 6th). If entering multiple children on 1 form, CHECK ALL THAT APPLY
Parent/guardian Name
Home Address
Parent/Guardian Phone Number *
Parent/Guardian Email Address
Emergency Contact Name (secondary to parent/guardian listed above) *
Phone Number for Emergency Contact *
I am the parent or legal guardian of the above listed child. I understand the Dike Public Library may photograph or videotape the events or activities in which my child will participate as part of Summer Reading Program during the month of June 2022. I give my permission for the library to use photographs and/or videos of my child during these activities for the purpose of promoting the library and its services/programs. I understand no compensation of any kind will be paid to me or my child at this time nor in the future for the use of my child's likeness. No child will be identified by name. *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms