1000 Books Before Kindergarten Registration Form

An early literacy program for pre-kindergarten children. (Ages: birth up to kindergarten)

Child's Last Name

This is a required question

Child's First Name

This is a required question

Child's Age

Age at time of sign-up.

This is a required question

Child's Birthday

Example: 08/02/2009

This is a required question

Address

street, city, state, zipcode

This is a required question

This is a required question

Guardian/Parent Full Name

first & last name

This is a required question

Phone Number

Guardian/Parent phone number -- Example: 765-123-9876

This is a required question

Has the child received the beginner package?

(This may be marked yes if you personally give them the package after getting them registered.)

This is a required question

Date Registered

Example: 08/11/12

This is a required question

MRL Validation Code

What is the override code used in the library catalog system?

This is a required question