Children’s Program Registration | Daniel Pierce Library

Child's Name*

First Last

Birthdate*

Age*

Email*

Phone*

Parent/Guardian Name*

First Last

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address

Street Address Address Line 2 City State ZIP Code

Complete only if different from physical address.

Emergency Contact Information

If parent cannot be contacted, who should be contacted in case of emergency?

Emergency Contact*

First Last

Emergency Contact Phone*

Please register for one program per child.

Mother Goose Time

12-23 Months (must be 12 months by 12/1/19)

Toddler Time

24-35 Months (must be 24 months by 12/1/19)

Story Hour

3, 4, & 5 Year Olds (must be 3 years by 12/1/19)

This program is open to Tri-Valley residents only.*

Weather Cancellations*

When the Tri-Valley Central School District is closed or delayed due to inclement weather, ALL storytimes will be cancelled.

Comments

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