Teen Online Registration Teen

Summer Reading Online Registration Form

Registration closes June 5. Reading logs and other forms must be picked up from the Library by June 10.

* Indicates required field

Name *

First

Last

Grade in September *

Age *

Email *

Phone Number *

Parent Or Guardian Name *

Please Provide Additional Helpful Information Concerning Your Child Including Any Allergies Or Health Issues. *

Email is our default method of communication. Please watch your email for updates and notifications. Announcements will also be made on our Facebook page.

I give permission for Collingsworth Public Library to post my child’s name in the library, exhibit arts or crafts made by my child with his/her name attached, use my child’s name and or picture in press releases, the library web page and Facebook page and inform my child’s principal and teacher of his/her participation in the Summer Reading Program. No compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my child’s likeness. Please note any allergies or health issues.

Submission of this form indicates permission agreement with the statements above.

Date *

Submit