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Click Submit when you're done to record your answers.

Please Print:

* 1st Preschool Child's FULL Name

* 1st Preschool Child's Birthdate

2nd Preschool Child's FULL Name

2nd Preschool Child's Birthdate

* Parent/Guardian's Name

Parent/Guardian's Phone

Parent/Guardian's Email Address

* Child's Home Address

Mailing Address (if different)

"This child is a resident of Bartow, Ft. Meade, Lake Wales, Lakeland, or Winter Haven" --By clicking "submit", you are electronically signing this form and agreeing with this statement.

Privacy Statement: This information will not be used for any purpose other than the Imagination Library

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Upcoming Events

Sep 26/23 11:30 AM - 01:00 PM Top Corporate Supporter Luncheon

Oct 02/23 - Oct 04/23 07:00 AM - 11:00 AM Pumpkin Latte Giveaway at Black & Brew

Oct 05/23 05:30 PM - 07:30 PM Cocktails & Conversation

Oct 18/23 04:30 PM - 06:30 PM Women United's Party with a Purpose

Oct 26/23 09:00 AM - 10:30 AM Publix Retiree Meet & Greet

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Polk, Hardee and Highlands Counties, Florida | Phone: 863-648-1500 | PO Box 1357, Highland City, FL 33846 Physical Location

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