Summer Reading Program Registration 2023
Join us for 7 weeks of WPCL's Summer Reading Program June 12th - July 28th!

Please visit www.westernpoconocommunitylibrary.org for program details.
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Which program(s) will you be attending? *
Required
Name of Parent/Guardian (Last, First) *
Email *
Address *
Phone number *
Name of Child #1 (Last, First) *
Age of Child #1 *
Name of Child #2 (Last, First)
Age of Child #2
Name of Child #3 (Last, First)
Age of Child #3
Name of Child #4 (Last, First)
Age of Child #4
Permission to videotape and/or photograph.  WPCL may photograph or videotape the events or activity which I am (or my child is) participating.  I give my permission for WPCL to use photographs or videotape of me (or my child) for the purpose of promoting WPCL and its services/programs.  I give my permission with the following understanding: no compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my (or my child's) likeness).  I understand if I choose "no" it is my responsibility to remove my child from the area in which photos are being taken. *
Required

WPCL's Summer Reading Program may include food programs, please note:

Ingredients and prepared food may contain or come into contact with allergens, such as dairy, eggs, soybeans, tree nuts, peanuts, fish, shellfish, sesame, or wheat.   If food allergies present medical issues for you or your child participants, please make an informed decision on whether it is appropriate or safe to participate in the program.

By signing up for this program, you understand that you are doing so at entirely your own risk and will not hold WPCL responsible.

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