REGISTRATION FORM FOR UPCOMING CHILDREN'S PROGRAMS
Contact us at 570.286.2461 OR   info@degensteinlibrary.org
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Name *
Email *
Child's First Name *
Child's Last Name *
Child's Age *
Programs
Dietary restrictions *
I grant the Degenstein Community Library, its representatives, employees and associates the right to take photographs of my child in connection with the 2023 Summer Reading Program. I authorize that they may copyright, use and publish the same in print or electronically. I agree that the Degenstein Community Library may use such photographs of my child with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising and Web content. *
Required

I grant permission for my chid(ren) to participate in any and all Degenstein Community Library program(s) with full knowledge of the risks involved and I hereby agree to assume those risks and to hold Degenstein Community Library, other sponsoring agencies and all of their representatives free from liability for any injury, harm, or complication resulting from said participation in any and all program(s). I have taken such measures that I have deemed advisable to ascertain that my child’s physical condition is suitable for the program (including a doctor’s physical, if appropriate). Furthermore, I do understand that accident insurance is not provided by Degenstein Community Library and/or other sponsoring agencies, and I hereby agree to assume full responsibility for any and all medical expenses resulting from any accidents or injuries suffered by me and/or my child while participating in said program(s). 

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