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Child's Name |
Phone # | ||||
Child's Date of Birth |
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Mailing Address |
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Child's Gender |
________________FEMALE
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_______________MALE |
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Parent or Guardian's Name(s) |
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Signiture of Parent or Guardian |
______________________________________________________________ Please Enroll my Child in Dolly Parton's Imagination Library |
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Send this application to the Henderson County Library.
Child MUST reside in Henderson County.