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
Parent or guardian's name
Child's home address
Child's mailing address (if different from home address)
Is this child a resident of Hancock, Harrison, Pearl River or Stone counties? If not, please visit
to see if the program is offered in your area.
What county are you a resident of?
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