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Rusk County Texas
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2023 Summer Reading Program
Mt. Enterprise Library Registration
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Please tell us about the Responsible Party for the Reader(s) you are registering.
Responsible Party First Name:
Responsible Party Phone:
Responsible Party Last Name:
Responsible Party Mailing Address:
Responsible Party Mailing Address City:
Responsible Party Mailing Address State:
Responsible Party Mailing Address Zip Code:
I am the Responsible Party for the child/children listed on this form.
YES
NO
Alternate Contact First Name:
Alternate Contact Last Name:
Alternate Contact Phone:
Child's First Name:
Child's Age
Child's Last Name:
Child's Mailing Address:
Child's Mailing Address City:
Child's Mailing Address State:
Child's Mailing Address Zip Code:
Child's Phone Number:
Child's School:
Child's Reading Level:
Number of Titles
Timed Readers
Young Adult
Child's Grade in the Fall:
Pre-Reader
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
PHOTO CONSENT:
I understand that the Mt. Enterprise Library may photograph, videotape, or audio record the events or activities in which I am (or my child is) participating. I give my permission for the library to use photographs, videotape, or audio recordings of me (or my child) for the purpose of promoting the library and its services/programs. I give my permission with the following understanding: No compensation of any kind will be paid to me (or my child) at this time or in the future for the use of my (or my child’s) likeness.
PHOTO CONSENT:
I DO give consent.
I DO NOT give consent.
An additional child may be registered in this section. If you do not need to register an additional child, please scroll down to the "
NEXT
" button.
Child's First Name:
Child's Age
Child's Last Name:
Child's Mailing Address:
Child's Mailing Address City:
Child's Mailing Address State:
Child's Mailing Address Zip:
Child's Phone Number:
Child's School:
Child's Reading Level:
Number of Titles
Timed Readers
Young Adult
Child's Grade in the Fall:
Pre-Reader
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
PHOTO CONSENT:
I DO give consent.
I DO NOT give consent.
An additional child may be registered in this section. If you do not need to register an additional child, please scroll down to the "
REMIND Notifications
" button.
Child's First Name:
Child's Age
Child's Last Name:
Child's Mailing Address:
Child's Mailing Address City:
Child's Mailing Address State:
Child's Mailing Address Zip Code:
Child's Phone Number:
Child's School:
Child's Reading Level:
Number of Titles
Timed Readers
Young Adult
Child's Grade in the Fall:
Pre-Reader
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
PHOTO CONSENT:
I DO give consent.
I DO NOT give consent.
An additional child may be registered in this section. If you do not need to register an additional child, please scroll down to the "
REMIND Notifications
" button.
Child's Name:
Child's Age
Child's Last Name:
Child's Mailing Address:
Child's Mailing Address City:
Child's Mailing Address State:
Child's Mailing Address Zip Code:
Child's Phone Number:
Child's School:
Child's Reading Level
Number of Titles
Timed Readers
Young Adult
Child's Grade in the Fall:
Pre-Reader
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
PHOTO CONSENT:
I DO give consent.
I DO NOT give consent.
REMIND:
Get information, updates, and alerts for the Summer Reading Program at the M.E. Library by signing up for our Remind! You don’t want to miss out on all the fun events, crafts, and movies at this year’s program. REMIND is a free messaging subscription you can cancel at anytime; it only pertains to events happening at this year’s Summer Reading Program.
Text the code @
mtesrp
to 81010 to sign up or allow us to sign up for you below!
REMIND Notifications:
YES - Sign me up so I don't miss any events!
NO - I'll take my chances or sign up on my own.
REMIND - Cell Phone:
This is only needed if you choose for us to sign you up for REMIND notifications.
How did you hear about our Summer Reading Program?
Past Participant
Friend
Facebook
Library Website
Brochure
School Handout
Staff Member
Newspaper
Local Newstation
Other
Provided by the Texas Association of Counties
Duties & Responsibilities of County Officials
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