Dolly Parton’s Imagination Library
Official Registration Form (one per child required)
Privacy Statement: This information will not be used for any purpose other than the Imagination Library.

Preschool Child’s FULL Name: _____________________________________________

Child’s Date of Birth: ________ / _______ / ___________

Sex:         Male             Female

Phone: _______________________________________________

Child’s Social Security Number (optional, used for identification only) ________________________

Parent / Guardian’s SS # (optional, used for identification only) _____________________________

Child’s Home Address ______________________________________________________

City: _______________________________ State: ________ Zip: __________________

“This child is a resident of Macon County, TN.” _______________________________
                                                                                               Signature of Parent or Guardian

 

For Office Use Only: Date Received: ________________ Group Code: __________

Sign up your child today!

Use your browser's PRINT button to print this page.  Fill out the form and mail it to:
Macon County Education Foundation, Inc.
P.O. Box 66
Lafayette, TN 37083
(615) 699-2705

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