Denver Public Library

Personal tools

You are here: Home / Children / Printable Registration Form for Summer Reading

Printable Registration Form for Summer Reading

Print out and mail or drop off at the Denver Public Library, 100 Washington Street, P.O. Box 692, Denver, IA 50622

A Universe of Stories 

 Denver Public Library

Summer Reading 2017 Registration Form

Program is open to children entering Kindergarten through 6th grade


Child’s Name _________________________________________________

Age_______________________ Grade Entering________________

Parent/Guardian Name_____________________________________




Emergency Contact Information (In case we cannot contact parent/guardian listed above)

Emergency Contact Name______________________________________________________

Phone number___________________Relationship to child___________________________

Does this person have permission to pick up your child?_____________________________

List any Food/Medical Allergies your child has_____________________________________

Waiver of Liability


(Must be read and signed by parent/guardian for child to participate in Summer Reading)

I hereby release The Denver Public Library/City of Denver staff from any liability for injuries incurred by my child while attending the summer reading program. In the event of a medical emergency, every effort will be made to notify me or the emergency contact.    I understand that my child will be expected to follow the safety and behavior rules set up by the library staff.   I give permission for photographs to be taken of my child to be used for publicity purposes.

Parent/Guardian Signature___________________________________________Date__________________     

« August 2020 »
This resource is supported by the Institute of Museum and Library Services under the provisions of the Library Services and Technology Act as administered by State Library of Iowa.