Summer Library Program Registration 2019
REGISTRATION GUIDELINES:
1) All programs are FREE!
2) Each participant must be registered separately
3) Each participant may only register ONCE
4) While all participants are welcome to attend any and all programs they wish, the specific library and age group designated on the registration form determines the grand prize drawing into which the participant will be entered
5) Please also register (only once) each parent/guardian that may be present at programs
Participant or Parent/Guardian *
Participant
Parent/Guardian
Choose 1
Library *
Lumberton
Oak Grove
Purvis
Sumrall
Choose 1
Program *
Pre-School
Children
Teen
Adult
Choose 1
Last Name *
Your answer
First Name *
Your answer
Address *
Please include street, city, state, and zip on one line.
Your answer
Phone Number *
Enter a phone number where the parent or guardian can be reached. Include area code. Ex: XXX-XXX-XXXX
Your answer
Parent or Guardian's Name
Required for participants under age 18
Your answer
Email Address
Email address where parent or guardian (or adult participant) may be reached.
Your answer
Age *
Grade Entering *
Grade that participant will be going into after summer break.
Publicity Disclaimer *
The library always takes photographs and videos of participants in all library programs and many of these photographs/videos are used on our website and social media pages and in other publicity. If you do not wish your child's image to appear online or in other publicity materials, it is your responsibility to keep your child out of the line of sight of our cameras and to monitor our online presences to watch for photographs/videos that were taken without your knowledge. If this happens, you can let us know and it will be taken down immediately.
Hold Harmless Statement - Agreement Required *
I hereby release Lamar County Library System, its employees and agents from any injury or damage I or my child may suffer as a result of our voluntary participation in this activity and I hereby hold harmless Lamar County Library System, its employees and agents from any and all liability as a result of any injury or damage, of whatever nature, I or my child may suffer as a result of our voluntary participation in this activity.
Do you have any food allergies? If so, please list them. *
Your answer
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