1000 Books Before Kindergarten
Please fill out 1 form per child.
Child's First and Last Name
Boy or Girl
Legal Guardian Name
Are you the legal guardian of this child?
I, the undersigned, do hereby grant or deny permission to the City of White House & the White House Library to use the image of my child or myself as marked by my selection below. Such uses includes the display, distribution, publication, transmission, or otherwise use of images taken of my child or myself for use in materials that include, but may not be limited to, printed materials, such as newspaper articles, brochures, newsletters, videos, and digital images such as those on any city websites.
Check those that apply.
Grant permission to use mine or my child's image and name on websites.
Grant permission to use mine or my child's image and name on newspapers.
Deny permission to use mine or my child's image and name.
Legal Guardian Signature
Date of Sign Up
Thank you for signing up your child up for 1000 Books Before Kindergarten! Stop by the library to pick up your 1000 Books material.
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