Toddler Time Registration Form (Ages 6 Months

2022-2023 Toddler Time Registration Form
Child's Name

First Name Middle Name Last Name
Address

Street Address

Street Address Line 2

City

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth
Age
Parent(s)/Guardian(s)
Email
example@example.com
Allergies

Yes No
If yes, allergic to
If another person besides parents will be bringing the child to Toddler Time, please fill out the following information:
Person #1
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City

Postal / Zip Code
Email
example@example.com
Person #2
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City

Postal / Zip Code
Email
example@example.com
Publication Consent Form

Dear Parent/Guardian:

At some time during the year, the library, newspaper, or television may videotape or photograph activities at Toddler Time. This form gives permission for the library to photograph or video tape your child.

As the parent(s)/guardian(s) of
Child's Name

First Name Last Name
I/we give the Metcalfe County Public Library permission to release my/our child's name, photography, audio/video production for publication to the general public concerning library and/or Story Hour events.
Parent(s)/Guardian(s) Signature

Clear
Date

Month Day Year
Date
Should be Empty:

2022-2023 Toddler Time Registration Form