4. First Name*
5. Last Name*
7. How many people would you like to register?*
   -- Select One --12345678910
8. List the names of registrants other than yourself.
   i.e. First Last, First Last, (Type n/a if not applicable).
10. Are registrants in grades 3 - 5?*

    1. Yes
11. Where did you hear about this program?*

    1. Facebook
    2. Twitter
    3. Tumblr
    4. Library Website

    1. Email
    2. Word of mouth
    3. Public posting / Flyer
    4. Media
13. Contact Info
15. Library card #
16. Zip Code*
18. Phone*
    (no spaces)
19. Email *
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field