Children’s Program Registration | Daniel Pierce Library

Child's Name*
First Last
Birthdate*
MM slash DD slash YYYY
Age*
Email*
Phone*
Parent/Guardian Name*
First Last
Physical Address*
Street Address Address Line 2 City State ZIP Code
Program Registration*
Please select the program that your child will be attending based on their age range.
Please indicate number of ADDITIONAL children attending the program*
Please enter a number from 0 to 5.
Weather Cancellations*
- I understand that ALL programs will be cancelled when the Tri-Valley Central School District is closed or delayed due to inclement weather.
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Comments
This field is for validation purposes and should be left unchanged.