Name of Adult filling out the form Required Address: Required Parent's phone number Required Name and Age of Children Participating in the 2022 Summer Reading Program Required Permission to Participate Required I give permission for the child/children listed above to participate in sponsored events at the H.F. & Maude E. Marchant Memorial Library in Scranton, Iowa, throughout the 2022-2023 school year. Which day will you participate in the Summer Reading Program? Required Monday afternoon 4 - 5 pm - 3rd grade and under Tuesday afternoon 4 - 5 pm - 4th grade and up Permission to Videotape and/or Photograph (Permission is not required to take part in city events.) I understand the City of Scranton may photograph or videotape the events or activities in which I am (or my child is) participating. I give my permission for the City to use photographs or videotape of me (or my child) for the purpose of promoting the City of Scranton and its services/programs. I give my permission with the following understanding: No compensation will be paid to me (or my child) at this time or in the future for the use of my (or my child's) likeness. I am the parent/legal guardian of the child(ren) listed above. Submit