Child's Address. Please include address, city, state and zip on one line.

Enter a phone number where the parent or guardian can be reached. This should be the primary phone. Include area code. Ex: XXX-XXX-XXXX

Email address where parent or guardian may be reached.

Grade that teen will be going into after summer break.

The library will occasionally take photographs or video of children in the summer reading program. Check below whether you give permission to the library to use these photographs/videos on the library's web site or in other publicity. *NOTE: if you do not wish for your child to be photographed, you will have to keep your child separated from the group and the child will have to wear a special sticker on his or her shirt so that staff can clearly see the child who cannot be photographed.

I hereby release Lamar County Library System, its employees and agents from any injury or damage I or my child may suffer as a result of our voluntary participation in this activity and I hereby hold harmless Lamar County Library System, its employees and agents from any and all liability as a result of any injury or damage, of whatever nature, I or my child may suffer as a result of my voluntary participation in this activity.