Summer Reading Program Registration/Permission Form

Child's First and Last Name Required

Child's Grade Just Completed Required

Parent/Guardian First and Last Name Required

Street Address Required

City, State, Zip Code Required

Home Phone or Cell Phone Number Required

Email Address Required

Registration/ Photo Release and Participation Permission Form Required

I hereby grant permission to the Villisca Public Library to use submitted photographs or video on our social media site and other official publications.

By submitting this form, you are granting permission to the following:

I understand the City of Villisca may photograph or videotape the events or activities in which my child is participating. I hereby grant permission to the City of Villisca to use submitted photographs and video on our social media sites, library websites, and other official publications. I give my permission with the following understanding that these photographs/video may be used for publication, advertisement, and promotions for the City of Villisca and/or Villisca Public Library website, Facebook, newsletters, scrapbooks, or other official publications and displays without further consideration or compensation. I also acknowledge their rights to edit photographs/video at their discretion. I hereby give permission and authorize the City of Villisca and/or Villisca Public Library to use and reproduce submitted photographs/video of my child/children for an undetermined time limit.

I hereby grant permission for my child/children to participate in an event sponsored by the Villisca Public Library. I give permission for my child/children to travel with and/or participate in the Villisca Public Library Summer Reading Program at the Villisca Public Library, Villisca Community Building, the Early Childhood Education Center (ECEC), and/or at the Villisca City Park.