DPIL Child Registration Form - Norris Giving Fund

Child Registration Form

Dolly Parton's Imagination Library by Norris Giving Fund
We are thrilled that you and your child are joining Dolly Parton's Imagination Library by Norris Giving Fund.

To sign up for Dolly Parton's Imagination Library by Norris Giving Fund, simply answer the questions below and click SUBMIT to complete your child's enrollment. All fields are required.

Please note that the child MUST RESIDE IN THE TOMBALL COMMUNITY (ZIP CODES 77375 or 77377) and the program is only for CHILDREN UNDER THE AGE OF FIVE (5) YEARS of age.
Parent's Name*

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Cell Phone Number
Please enter a valid phone number.
Parent Email
example@example.com
Child's Name

First NameLast Name
Child's D.O.B

MonthDayYear
Age
Child's Address if different than address above
Child's Sex:

FM
Are you enrolling your Newborn Baby? If so, at which hospital was your baby born?
Hospital name or n/a
Would you like to enroll another child?

I would like to enroll another childNo thanks
2nd Child's Name

First NameLast Name
2nd Child's D.O.B

MonthDayYear
2nd Child's Age
Consent

"I hereby explicitly consent to allow the Dollywood Foundation, Inc. to use the information provided herein for the purposes of participating in Dolly Parton's Imagination Library book gifting program. To measure the benefits of this program we may create datasets with the information provided herein and share them with research and educational advancement partners. You agree to review our full Terms & Conditions and Privacy Policy by visiting imaginationlibrary.com. By signing and submitting this form, you expressly consent to the terms set forth herein."
Signature*

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Parent Signature
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