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DOLLY PARTON’S IMAGINATION LIBRARY OFFICIAL REGISTRATION FORM Child’s Name: First Name Last Name Child’s Date of Birth: / / Sex: M F Phone: MONTH DAY YEAR Authorized Adult’s Name: First Name Last Name Authorized Adult’s Address: ADDRESS CITY STATE ZIP Authorized Adult’s Email Address: Child’s Home Address: ADDRESS CITY STATE ZIP Mailing Address: (If Different) ADDRESS CITY STATE ZIP I hereby explicitly consent to allow the Dollywood Foundation, Inc. to use the information provided herein for the purposes of participating in Dolly Parton’s Imagination Library book gifting program. To measure the benefits of this program we may create data sets with the information provided herein and share them with research and educational advancement partners. You agree to review our full Terms & Conditions and Privacy Policy by visiting imaginationlibrary.com. By signing and submitting this form you expressly consent to the terms set forth herein. Authorized Adult Signature: The Dollywood Foundation is a 501(c)(3) public nonprofit organization. FOR OFFICE USE ONLY: Date Received: Group Code. Return to Alpine County Friends of the Library PO box 187 Markleeville, CA 96120 [PHONE REDACTED]