Name: Summer Book Club
Start: 2025-06-25T09:00:00-04:00
End: 2025-07-16T11:00:00-04:00

Participant First Name*

Participant Last Name*

Participant DOB

Please list any allergies participant has*

Which School does Participant attend?

Email*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Phone

Name of individual picking up participant*

Emergency Contact Phone Number*

Emergency Contact Name*

I grant Tri-Town Youth Services permission to use my/my child’s image in photos or videos for promotional, educational, and outreach purposes, including print, digital, and social media. I understand no compensation will be provided, and I release Tri-Town Youth Services from any liability related to image use.*

Yes

No

Summer Book Club

June 25 @ 9:00 AM - July 16 @ 11:00 AM

Details

Organizer

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