Week of Fun Week of Fun Registration Child's Name* First Last Child's Date of Birth* MM DD YYYY Parent/Guardian's Name* First Last Parent/Guardian Phone Number*Address* Street Address Mailing Adress (if different from above) City State / Province / Region ZIP / Postal Code Parent/Guardian Email* Does your child have any allergies?* Yes No Please list any known allergies belowGrade Entering in Fall 2018*Please enter a value between 1 and 9.Emergency Contact Name* First Last Emergency Contact Phone Number*Second Emergency Contact Name* First Last Second Emergency Contact Phone Number*Photo Permission* Yes, I give permission No, I do not give permission Please check above to give the Daniel Pierce Library permission to photograph and/or record your child during events or activities in which he or she is participating. We will use them for social media and marketing purposes only. Payment Agreement* I have read and understand the Payment Agreement Payment in the amount of $50 will be required upon drop off of your child on August 13, 2018. Cash or checks made payable to Daniel Pierce Library will be accepted.