Summer Reading 2021 Registration Form

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Summer Reading Registration

Participant's First & Last Name (One participant per registration - please complete an additional registration "form" for each additional participant - thanks!) *

Street Address *

City, State, Zip *

Grade going into this fall *

Parent/ Responsible Contact Info for Minors-First & Last Name & Phone # (if registering an adult, indicate N/A) *

Permission for minor's name/likeness to be used in media (no compensation is offered for use of likeness) *

I GIVE permission for my name/likeness (if adult) or this minor's name/likeness to be used in the newspaper, social media, etc.

I DO NOT GIVE permission for my name/likeness (if adult) or this minor's name/likeness to be used in the newspaper, social media, etc.

Children age 7 or younger must be accompanied by responsible caregiver 12 years of age or older. Library is not responsible for unattended children. I understand my child will only receive prizes for Summer Reading if reading logs are submitted by Friday July 23 at Library close of business. No exceptions will be made. *

check to acknowledge reading of the above statement.

Required

By signing my name below, I agree that I am registering myself, or a minor child for whom I am responsible in the Valley Center Public Library Summer Reading Program. *

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