Kids Summer Reading Adventure Club Registration Form

Kids Summer Reading Adventure Club Registration Form

Please fill out this form to register for the summer reading program.
Participant's Full Name

First NameLast Name
Participant's Age
Grade Completed
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies or Medical Conditions
Preferred Types of Books or Favorite Authors
How did you hear about the Kids Summer Reading Adventure Club?
Permission to take photos of child to use in on social media
Should be Empty: