DPIL - North Central Regional Betterment Coalition

Registration Form

Child Information

1st Child's Full Name

Child's Date of Birth

2nd Child's Full Name

Child's Date of Birth

Child's Mailing Address

City

State

Zip

Caretaker Information

Authorized Adult Name

Phone

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 datasets 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.

Registration Form

Child Information

Caretaker Information

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