Join Us for Your Summer Adventures!
May 26th - August 3rd
Summer Reading Registration
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Would you like to register for summer reading?
Yes
No
Do you have a child to register?
Yes
No
Child's name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Do you have second child to register?
Yes
No
Second child's name
First Name
Last Name
Second child's birthday
-
Month
-
Day
Year
Date
Do you have third child to register
Yes
No
Third child's name
First Name
Last Name
Third child's birthday
-
Month
-
Day
Year
Date
Do you have a fourth child to register
Yes
No
Fourth child's name
First Name
Last Name
Fourth child's birthday
-
Month
-
Day
Year
Date
Do you have a fifth child to register?
Yes
No
Fifth child's name
First Name
Last Name
Fifth child's birthday
-
Month
-
Day
Year
Date
Do you have a sixth child to register?
Yes
No
Sixth child's name
First Name
Last Name
Sixth child's birthday
-
Month
-
Day
Year
Date
Do you have a seventh child to register?
Yes
No
Seventh child's name
First Name
Last Name
Seventh child's birthday
-
Month
-
Day
Year
Date
How did you hear about our summer reading program?
Website
Flyer
School
Word of mouth
Middleton Gazette
Other
Please let us know why you participate in summer reading with the Middleton Public Library in order of importance. (i.e. check the number 1 box for the most important reason, 2 for the second most important reason etc etc)
Rows
1
2
3
4
We love to read
We are avoiding the summer slide
Prizes
Keeps the kids busy
Submit
Should be Empty: