Haltom City Public Library 2017 Summer Reading Club Enrollment
If registering as an adult, please fill out the first four questions.
Name of Participant
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Telephone Number
Your answer
If registering a child, please provide the following information:
Parent/Guardian Name
Your answer
Parent/Guardian Email Address
Your answer
What school does the participant attend?
Your answer
Participant's Age
Your answer
Grade Completed
Your answer
Reading Options
As a parent of this child or these children, I give my permission for them and myself to be photographed or filmed for publicity purposes.
Today's Date
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