Summer Reading 2017
Please fill out 1 Summer Reading Registration form per person.
Participant's First & Last Name
Boy or Girl
Age (for ages 0-17 only)
*If you are an adult (age 17 or older), please skip to Reading Age Group.
Reading Age Group (If between age 12 & 13, child's choice of Reading Age Group.)
Listener/Reader (ages 0-6)
Kids (ages 7-12)
Teens (ages 12-17)
Adult (ages 17+)
Legal Guardian Name (for participants ages 0-17 only)
*If you are an adult (age 17 or older), please skip to Phone Number.
Are you the legal guardian of this child?
Signing up as an adult.
I, the undersigned, do hereby grant or deny permission to the City of White House & the White House Library to use the image/video of my child(s)/teen(s) or myself as marked by my selection below. Such uses includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child/teen 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. If there are any other specifications needed, please select "Other" and fill in the space provided (i.e. picture only, no name).
Grant permission to use mine, my child, or my teen's image and name on websites.
Grant permission to use mine, my child, or my teen's image and name on newspapers.
Deny permission to use mine, my child, or my teen's image and name.
Legal Guardian Signature
If you are signing up as an adult, please sign below.
Thank you for signing up for Summer Reading!
Make sure to stop by the library to pick up your Summer Reading kit beginning Tuesday, May 30th. If you have any questions, please call 615-672-0239.
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