Summer Reading Registration Form

2019 Summer Reading Registration & Permission Form
Please complete this form and agree to the terms before submitting. If you have more than one child to register, please use the boxes labeled additional child to their information. Sessions are on Tuesdays and Thursdays from
1-2:30 PM starting July 9 and ending July 25. See you there!
Please list Name, Age and "Grade going into" for each additional child
Please list Name, Age and "Grade going into" for each additional child
Please list Name, Age and "Grade going into" for each additional child
This is for notification purposes only.
Feel free to contact us at 438-5581 or email kcpld.eads@gmail.com for assistance

BY SUBMITTING THIS FORM
I give permission for my child to attend the 2019 Summer Reading Program on
July 9, 11, 16, 18, 23 & 25, 2019 from 1:00-2:30 PM.
I understand that this program involves exercise, movement and being outdoors. The Kiowa County Public Library District and its staff and volunteers are not liable for potential injuries. I agree that my child can participate in outdoor activities as well as walk to other locations within Eads, CO (with library staff and volunteers present) to attend special events. I understand that KCPLD will notify me by note, phone and/or email to inform me when and where a special event will occur.
KCPLD has my permission to photograph and/or videotape my child, and that the library may use these for marketing and on social media sites like Facebook. I understand that no compensation of any kind will be paid now or in the future for the use of my child's likeness.

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