Back to School Boot Camp 2022
Juliette Hampton Morgan Memorial Library Student Registration
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Email *
Select your child's grade range: *
Required
Student Name *
Grade *
Child's Birth Date *
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DD
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YYYY
Age *
Address *
Zip code: *
Phone (Home): *
Work Phone of Parent Guardian: *
Cell: *
Name of Parent or Guardian *
In case of emergency, if parent or guardian cannot be reached, please call: Name *
Emergency Contact Home phone: *
Emergency Contact Cell phone *
Emergency Contact Relationship *
Language spoken at home: *
Parental Permissions: My child may be photographed for Back to School Boot Camp publicity and any other publicity that is designed to advertise the many activities going on in our libraries. *
Parental Permissions: Medical waiver: permission is granted to supervising staff to provide necessary first aid in an emergency if parent, guardian or emergency contact cannot be contacted using the above numbers. If secondary medical assistance is required, the library/city/county will not assume any liability for charges arising from medical assistance *
Parental Commitment
By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Parental Commitment: My child and I know that library rules must be followed or he/she will be asked to go home for the day. I know that Boot Camp classes are not a childcare program; therefore, I will insist that my child take part in the planned activities that are designed to help him/her understand the many valuable resources available in our public library.                                       (Please fill in the text with Guardian Full Name) *
Student Commitment
By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Student Full Name: *
Parent Full Name: *
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