DOLLY PARTON'S IMAGINATION LIBRARY
This form serves as the official registration form for the Dolly Parton's Imagination Library program offered by United Way of South Mississippi.
Child's Full Name *
Child's date of birth *
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Child's gender *
Parent or guardian's name *
Phone number *
Child's home address *
Child's City/State/Zip *
Child's mailing address (if different from home address)
Email address
Is this child a resident of Hancock, Harrison, Pearl River or Stone counties? If not, please visit https://imaginationlibrary.com/check-availability/ to see if the program is offered in your area. *
What county are you a resident of? *
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