Summer Reading 2021 Registration Form
Summer Reading Registration
Participant's First & Last Name (One participant per registration - please complete an additional registration "form" for each additional participant - thanks!)
City, State, Zip
Grade going into this fall
Infant-Toddler not yet in Preschool
Parent/ Responsible Contact Info for Minors-First & Last Name & Phone # (if registering an adult, indicate N/A)
Permission for minor's name/likeness to be used in media (no compensation is offered for use of likeness)
I GIVE permission for my name/likeness (if adult) or this minor's name/likeness to be used in the newspaper, social media, etc.
I DO NOT GIVE permission for my name/likeness (if adult) or this minor's name/likeness to be used in the newspaper, social media, etc.
Children age 7 or younger must be accompanied by responsible caregiver 12 years of age or older. Library is not responsible for unattended children. I understand my child will only receive prizes for Summer Reading if reading logs are submitted by Friday July 23 at Library close of business. No exceptions will be made.
check to acknowledge reading of the above statement.
By signing my name below, I agree that I am registering myself, or a minor child for whom I am responsible in the Valley Center Public Library Summer Reading Program.
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