Summer Library Program Registration 2018 ~ Sumrall Public Library
All programs are FREE! Please register each teen separately. Be sure to pick up your registration packet at the library on or after May 31, 2017. Programs will be on Tuesdays in June at 2 pm in the library. Water day will be on Friday, July 13 from 2 - 4 pm.
Last Name *
Your answer
First Name *
Your answer
Address *
Child's Address. Please include address, city, state and zip on one line.
Your answer
Phone Number *
Enter a phone number where the parent or guardian can be reached. This should be the primary phone. Include area code. Ex: XXX-XXX-XXXX
Your answer
Parent or Guardian's Name *
Your answer
Email
Email address where parent or guardian may be reached.
Your answer
Age *
Your answer
Grade Entering *
Grade that teen will be going into after summer break.
Your answer
Publicity *
The library will occasionally take photographs or video of children in the summer reading program. Check below whether you give permission to the library to use these photographs/videos on the library's web site or in other publicity. *NOTE: if you do not wish for your child to be photographed, you will have to keep your child separated from the group and the child will have to wear a special sticker on his or her shirt so that staff can clearly see the child who cannot be photographed.
Required
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 my voluntary participation in this activity.
Required
Do you have any food allergies? If so, please list them. *
Your answer
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