Online Program Registration

When registering online, you will be asked to complete these sections:

1. Program registration
2. Permission for your child to be picked up by others (if any)
3. Authorization for emergency medical care
4. Photo release agreement (The full agreement is attached below.)
5. Release waiver form  (The full agreement is attached and needs to be signed and returned to the library.)

Please submit one online form per child. If you need help, ask any staff member at your branch. Fraser Valley 726-5689, Granby 887-2149, Hot Sulphur Springs 725-3942, Juniper 627-8353 and Kremmling 724-9228.

Program Registration

Today's date:

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year201020112012201320142015

Program (branch) Location: *

Fraser Valley

Granby

Hot Sulphur Springs

Juniper @ Grand Lake

Kremmling

Program Type: *

After School Club

Summer Reading Program

Other

Participant's Name: *

Age: *

Grade:

Teacher: *

Parents'/Guardians' Names: *

E-mail Address: *

Emergency Phone Number: *

Other/Home Phone:

Mailing Address:

My child has a library card:

YES

NO

Child's Library Account (barcode):

Your library account number (barcode) is located on your library card.

Permission to Leave the Program Unsupervised: *

YES, my child may leave the program unsupervised.

NO, my child may not leave the program unsupervised.

Pickup Permission(s)

The following people have my permission to pick up my child.  (Note:  Library staff will only release a child to a person on this list.)

Pickup Permission 1:

Pickup Permission 3:

Pickup Permission 2:

Authorization for Emergency Medical Care

Emergency Medical Care: *

YES, I authorize the library to seek medical treatment for my child should an emergency arise. I acknowledge that the cost of the medical treatment is my responsibility.

Photo Release Agreement

Please see the attached agreement below.

Photo Release: *

YES, the library may use my child's photo in print, electronic, and video publications and identify my child by name.

YES, the library may use my child's photo in print, electronic, and video publications but may NOT identify my child by name.

NO, the library may not use my child's photo in any print, electronic, and video publications.

Release Waiver Form

Please sign the attached form and bring to the first day of the program or drop the form at the library any time before the first day of the program.

Release Waiver Form Signed: *

YES, I have opened the attached GCLD Release Waiver (at the bottom of this page), printed the document, and signed the document.  My child will bring the signed Release Waiver or I will drop the Release Waiver at the library ahead of time.

Additional Info:

Please explain any special needs your child may have.

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.