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Board Game Club - Grades 4/5                                         9/24*, 10/22*, 11/19     3:15pm-4:00pm  
Please fill out this form if you would like to register your child for the program.  When you fill out this form, it is for all meeting dates for this program.  

*9/24 & 10/22  are early dismissal days for Region 12 and the program will be from 12:45pm -1:30pm.* 

If your child is a Burnham School student, you must still contact the school office to give permission for your child to be picked up from the school on the day of the program.  Please email Mrs. Lianne if you have any questions at lambruso@burnhamlibrary.org. Please note that registration ends the Friday before the program.   
Email *
Child's First Name  *
Child's Last Name  *
Parent's First and Last Name  *
Parent's phone number (at day/time of event) *
Emergency Contact Name & Number *
Child's Age & Grade (if applicable) *
Does your child have any allergies?  *
If you answered yes above, please explain
Do you give permission for a member of the library staff to walk your child from the Burnham School to the Burnham Library?  *
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