CCPL Summer Reading 2017 Build a Better World!
June 6-July 11, 2017
Tuesdays 10:30-11:30 & Thursdays 9:30 - 12 (optional)
Crittenden County Public Library, 204 W. Carlisle St., Marion
270-965-3354 or
Child's Name *
Your answer
Child's Age: *
Your answer
Child Entering Grade: *
Your answer
Is child an independent reader? *
Parent/Guardian Name: *
Your answer
Contact/Emergency phone: *
Your answer
Person accompanying child to library: *
Your answer
Email *
Your answer
Allergies? Fears? Anything we need to know about?
Your answer
Permission to Photograph and/or Videotape
I understand CCPL (Crittenden County Public Library) may photograph or videotape the events or activities in which I am (or my child is) participating. I give my permission for CCPL to use photographs or videotape of me (or my child) for the purpose of promoting CCPL and its services/programs. I give my permission with the following understanding: No compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my (or my child’s) likeness.
Permission is not required to take part in CCPL events.
I am the legal guardian of: *
Your answer
I give permission to photograph and/or videotape. *
Your name: *
Your answer
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