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2. Dolly Parton's Imagination Library Registration Form

4. 

6. Child's First Name:*

7. Child's Last Name:*

9. Child's Date of Birth:*
   Child's Date of Birth:

10. Sex:*

    1. Male
    2. Female

14. Authorized Adult's First Name:*

15. Authorized Adult's Last Name:*

17. Phone number:*

19. Authorized Adult's Address:*

21. City:*

22. State:*

23. Zip:*

25. Authorized Adult's email address:

29. Child's Home Address:*

31. City:*

32. State*

33. Zip:*

35. Mailing Address (if different):

37. City:

38. State:

39. Zip:

43. Authorized Adult Agreement:*

    1. I agree

    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.

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45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

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