Your Information Library Card Number: Please enter the library card for the child/teen who is going to participate in the program. You cannot use another person's library card to participate in JPL's Summer Reading Program. This for is for children and teens only. Adults who wish to sign up for the Adult Summer Reading Program, please use the adult registration form. First Name: Middle Initial: Last Name: Birth Date:(mm/dd/yyyy) Age: Parent/Guardian Name: Contact Information Phone number: Email address: School Information School information is for statistical purposes only. School Name: Not in School Home School Alexandria Elementary School Alexandria Middle School Alexandria High School Anniston Middle School Anniston High School C.E. Hanna Elementary School Children's House Daycare Cobb Elementary School Coldwater Elementary School DeArmanville Elementary School Donoho School Faith Christian High School Golden Springs Elementary School Jacksonville Christian Academy JCA Daycare Jacksonville High School Kids First Daycare Kitty Stone Elementary School Ohatchee Elementary School Ohatchee High School Oxford Elementary School Oxford Middle School Oxford High School Piedmont Elementary School Piedmont Middle School Piedmont High School Pleasant Valley Elementary School Pleasant Valley High School Precious In His Sight Daycare Randolph Park Elementary School Sacred Heart of Jesus Catholic School Saks Elementary School Saks Middle School Saks High School Spring Garden High School Tenth Street Elementary School Trinity Christian Academy Weaver Elementary School Weaver High School Wee Care Daycare Wellborn Elementary School Wellborn High School White Plains Elementary School White Plains Middle School White Plains High School Other School not on this list Other School - not listed above: Grade Completed at end of current school year: Not yet in school Pre-School/Pre-Kindergarten Kindergarten First Grade Second Grade Third Grade Fourth Grade Fifth Grade Sixth Grade Seventh Grade Eighth Grade Ninth Grade Tenth Grade Eleventh Grade Twelfth Grade Grade level information is is used to help determine what books would be on the child's reading level. If your child reads below grade level, please tell a staff member so we will be able to help him/her find books that he/she would enjoy. Please check if your child will be coming to the library with a Daycare Group this summer. Name of Daycare: How did you hear about the Summer Reading Program? I have participated in the Summer Reading Program at JPL before. A Library staff member told me about the program. I saw a flyer or sign in the library about the program. I saw a flyer or sign at another location for the library’s Summer Reading Program. I saw the information on the library’s website. I saw a post on the library’s Facebook page. I saw the informaiton in the library’s e–newsletter. I heard about the program at school. I saw an ad in the newspaper. I saw an ad on television. I head about it on the radio. A friend or relative told me about the program. I heard about the progam another way. If other, please list how you found out about the Summer Reading Program here: I agree to abide by the guidelines of the Jacksonville Public Library Summer Reading Program.