EmailMeForm
DPL Summer Reading Registration
If you cannot make it into the library to sign up your child for Summer Reading, fill out and submit this form!
LAST NAME:
*
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
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Email
*
Child #1
Child Name:
Middle Initial:
School:
Grade:
Age:
Child #2
Child Name:
Middle Initial:
School:
Grade:
Age:
Child #3
Child Name:
Middle Initial:
School:
Grade:
Age:
Child #4
Child Name:
Middle Initial:
School:
Grade:
Age:
Child #5
Child Name:
Middle Initial:
School:
Grade:
Age:
Parent's Name
*
First
Last
Date Time
*
MM
/
DD
/
YYYY
