Summer Reading Program Registration

Summer Reading Program Registration
Register to participate in our Summer Reading Program. Please complete all required fields to enroll.
Participant's Full Name
First NameLast Name
Participant's Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant's Age Group
Participant's Email Address
example@example.com
Participant's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Full Name (if participant is under 18)
First NameLast Name
Parent/Guardian Email Address
example@example.com
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Reading Genres (select all that apply)
Other
Have you participated in our Summer Reading Program before?
Please list any allergies, medical conditions, or special needs we should be aware of.
Additional Comments or Questions
Should be Empty: