DRML & JTL Summer Reading Program 2020
Please list first and last name. (Ex: Amelia Bedelia)
Please select your current age from the drop-down menu.
School I attend:
Please select which school/program you currently attend. (Ex: The Way Side School)
Browns River Middle School
Jericho Elementary School
Mount Mansfield Union High School
Mansfield Cooperative School
Poker Hill School
Saxon Hill Co-Op
Smilie Memorial School
Underhill Central School
Please select the grade level you will be entering.
Phone number where you can be reached:
Email address where you can be reached:
Do you (or a family member) have a library card?
Yes, of course!
Not yet--but I'm interested in getting one!
I'm not sure.
My home library is:
This question is for data collection only. DRML & JTL super duper love each other and are just glad that you're accessing libraries. Please don't fret over your answer. <3
Deborah Rawson Memorial Library
Jericho Town Library
I really don't know, but I love them both!
Which end of summer PRIZE would you like to be entered for?
The Grouchy Lady Bug plush toy and hardcover book
Mountain High Pizza $20 Gift Certificate (2 available)
Turner Toys $20 Gift Certificate
Mini Air Hockey Table
Phoenix Books $20 Gift Certificate (2 available)
Gift Certificate for Creemees from JCCS (5 available)
I hereby grant and authorize to take photographs as detailed below:
I hereby grant and authorize the Deborah Rawson Memorial Library and/or Jericho Town Library the right to take, edit, alter, copy, exhibit, publish, distribute, re-post, and make use of any and all pictures or video taken of me, or shared by me digitally in conjunction with library content, to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of Deborah Rawson Memorial Library and/or Jericho Town Library and will not be returned. I hereby hold Deborah Rawson Memorial Library and/or Jericho Town Library harmless, and release from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.
Yes, I agree. Use as many photos as you'd like!
Is there anything else you'd like us to know?
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This form was created inside of Jericho Town Library.