Library Reading Challenge Enrollment Form

Participant Full Name

First NameLast Name

Date of Birth

Date

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Preferred Reading Genres

Which age group do you belong to?

Have you participated in this challenge before?

Emergency Contact Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

If participant is under 18, please provide parent/guardian name

Reading Challenge Goal (number of books you hope to read)

What are you most excited about in this reading challenge?