REGISTRATION - 2022 Summer Reading Program

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Carthage Free Library - Program Runs July 5 - August 12, 2022

Email *

Child's Name *

Age *

School Grade Entering *

School District Attending/Homeschooled *

Military Family Y/N *

Yes

Required

Any Allergies? *

Parent's or Guardian's Name *

Parent's or Guardian's Phone Number *

Emergency Contact Name *

Emergency Contact Phone Number *

Who Has Permission Pick Up the Child from the Reading Program? *

Has the Child Participated in the Summer Reading Program Before?

Yes

Maybe

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Special Needs? Questions?

Release of Picture for Library Publicity

I give my permission for the publication of photographs taken while at Carthage Free Library for use on the web page, press releases, or other library publicity.

Photos showing myself and family members who are minors may be used.

Please indicate your/child's consent to be photographed

Yes

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