FOR OFFICE USE ONLY: ______“This child is a resident of herein. consent to the terms set forth advancement partners. You to review our full agree Terms visiting imaginationlibrary.com. & Conditions and Privacy Policy by you expressly By signing and submitting this form program.book gifting To provided herein and share them with research educational with the information datasets create we may measure the benefits of this program Foundation, consent to allow the explicitly I hereby Inc. Parton’s in Dolly the purposes of participating provided herein for to use the information Library Imagination Email Address Mailing Address Child’s Home Address Parent/Guardian’s Name Child’s Date of Birth 2 Child’s Date of Birth 1st FOR OFFICE USE ONLY: ______“This child is a resident of herein. consent to the terms set forth advancement partners. You to review our full agree Terms visiting imaginationlibrary.com. & Conditions and Privacy Policy by you expressly By signing and submitting this form program.book gifting To provided herein and share them with research educational with the information datasets create we may measure the benefits of this program Foundation, consent to allow the Dollywood explicitly I hereby Inc. Parton’s in Dolly the purposes of participating provided herein for to use the information Library Imagination Email Address Mailing Address Child’s Home Address Parent/Guardian’s Name Child’s Date of Birth 2 Child’s Date of Birth 1st ’s IMAGINATION LIBRARY Official Registration Form Dolly Parton’s IMAGINATION LIBRARY Official Registration Form nd Preschool Child’s FULL Name nd Preschool Child’s FULL Name Preschool Child’s FULL Name Preschool Child’s FULL Name

______(if different) (if different)

______

______CITY ______CITY ______ADDRESS CITY ______CITY ______ADDRESS Date Received: Date Received:

______

MSAD-55, ME. MSAD-55, ME.

MSAD-55ME." Denmark or Brownfield, Limington, Newfield, Limerick, or MSAD-55ME." Denmark or Brownfield, Limington, Newfield, Limerick, or

______ADDRESS ADDRESS / / / / ______

______

______

______” ” / / / /

______SIGNATURE SIGNATURE

OF OF

PARENT PARENT STATE STATE STATE STATE Sex: M F Sex: M F Sex: M F Sex: M F

/ / GUARDIAN GUARDIAN

Group Code: Group Code:

ZIP ZIP ZIP ZIP

Phone Phone Phone Phone CODE CODE CODE CODE

______

– – ______

Cut Here Cut Here Sign up your child today! Sign up your child today! Simply fill out the above form and mail to: Simply fill out the above form and mail to: Friends of Porter 569 Friends of Porter 569 P. O. Box 343 P. O. Box 343 Parsonsfield, ME 04047 Parsonsfield, ME 04047 (207) 200-5032 (207) 200-5032