* By registering myself or my child for the Summer Reading Program, I agree to the following: “As a Summer Reading Program participant, I agree to the use of my picture for library publicity in either web format or print. I know that the library staff will not illegally use my picture in any way. I fully support the Pope County Library System’s use of my picture.”

* By signing below, I agree to the following: “As a parent/guardian, I give permission for my child to be involved with the PCLS Summer Reading Program and all activities offered. Furthermore, I understand that the PCLS and its employees will not be liable or held responsible for injuries. I also agree for my child to be photographed, and for those photographs to be used as described above.”

* Location

* Digital Signature

TEEN SUMMER READING PROGRAM

Teen 1

* First Name

* Last Name

* Grade (Next Fall)

* School

* Address

* City

* State

* Zip

* Phone

* Email

Teen 2

First Name

Last Name

Grade (Next Fall)

School

Address

City

State

Zip

Phone

Teen 3

First Name

Last Name

Grade (Next Fall)

School

Address

City

State

Zip

Phone

* Location

* Digital Signature

ADULT SUMMER READING PROGRAM

* First Name

* Last Name

* Address

* City

* State

* Zip

* Phone

* Email

* Location

* Digital Signature