The Rotary Club of Charlottesville

Presents

What Is It?Dolly Parton’s Imagination Library is a 60 volume set of books beginning with the children’s classic The Little Engine That Could™. Each month a new, carefully selected book will be mailed in your child’s name directly to your home. Best of all it is a FREE GIFT! There is no cost or obligation to your family.

Who Is Eligible?Preschool children ages birth to five who are residents of zip code 22901, 22902 or 22903.

What Are My Responsibilities?1. Be a legal resident of zip code 22901, 22902

or 22903.

2. Submit an official registration form, completely filled out by parent or guardian. (Form must be approved and on file with The Rotary Club of Charlottesville.)

3. Notify The Rotary Club of Charlottesville any time your address changes. Books are mailed to the address listed on the official registration form. If the child’s address changes, you must contact the folks at the address on this card in order to continue receiving books.

4. Read with your child. When Will I Receive Books?Eight to ten weeks after your registration form has been received, books will begin arriving at your home and will continue until your child turns five or you move out of zip code 22901, 22902 or 22903.

The Rotary Club of Charlottesville

Presents

What Is It?Dolly Parton’s Imagination Library is a 60 volume set of books beginning with the children’s classic The Little Engine That Could™. Each month a new, carefully selected book will be mailed in your child’s name directly to your home. Best of all it is a FREE GIFT! There is no cost or obligation to your family.

Who Is Eligible?Preschool children ages birth to five who are residents of zip code 22901, 22902 or 22903.

What Are My Responsibilities?1. Be a legal resident of zip code 22901, 22902

or 22903.

2. Submit an official registration form, completely filled out by parent or guardian. (Form must be approved and on file with The Rotary Club of Charlottesville.)

3. Notify The Rotary Club of Charlottesville any time your address changes. Books are mailed to the address listed on the official registration form. If the child’s address changes, you must contact the folks at the address on this card in order to continue receiving books.

4. Read with your child. When Will I Receive Books?Eight to ten weeks after your registration form has been received, books will begin arriving at your home and will continue until your child turns five or you move out of zip code 22901, 22902 or 22903.

Dolly P

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Dolly P

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Sign up your child today!Simply fill out the above form and mail to:

Sign up your child today!Simply fill out the above form and mail to:

Privacy Statemen

t: This in

formation

will n

ot be used for an

y purpose oth

er than

that related to th

e Imagin

ation Library. PLE

AS

E PR

INT

Privacy Statemen

t: This in

formation

will n

ot be used for an

y purpose oth

er than

that related to th

e Imagin

ation Library. PLE

AS

E PR

INT

1st Prescho

ol C

hild’s FU

LL Nam

e ____________________________________________________________________________________

Ch

ild’s Date o

f Birth

________/___________

/ ___________

Sex: M

F Ph

on

e ____________________________________

2nd Presch

oo

l Ch

ild’s FULL N

ame ___________________________________________________________________________________

Ch

ild’s Date o

f Birth

________/___________

/ ___________

Sex: M

F Ph

on

e ____________________________________

Parent/G

uardian

’s Nam

e ____________________________________________________________________________________________

Ch

ild’s Ho

me A

ddress _______________________________________________________________________________________________

ad

dr

es

s

_______________________________________________________________________________________________

c

ity

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tat

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zip c

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Mailin

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a

dd

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ss

(if different)

_______________________________________________________________________________________________

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ip co

de

Em

ail Address ______________________________________________________________________________________________________

“Th

is child is a residen

t of zip

code 2

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01

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2 o

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ate Received: _____________________

G

rou

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de: ____________–_______________________

1st Prescho

ol C

hild’s FU

LL Nam

e ____________________________________________________________________________________

Ch

ild’s Date o

f Birth

________/___________

/ ___________

Sex: M

F Ph

on

e ____________________________________

2nd Presch

oo

l Ch

ild’s FULL N

ame ___________________________________________________________________________________

Ch

ild’s Date o

f Birth

________/___________

/ ___________

Sex: M

F Ph

on

e ____________________________________

Parent/G

uardian

’s Nam

e ____________________________________________________________________________________________

Ch

ild’s Ho

me A

ddress _______________________________________________________________________________________________

ad

dr

es

s

_______________________________________________________________________________________________

c

ity

s

tat

e

zip c

od

e

Mailin

g Address _____________________________________________________________________________________________________

a

dd

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ss

(if different)

_______________________________________________________________________________________________

cit

y

sta

te

z

ip co

de

Em

ail Address ______________________________________________________________________________________________________

“Th

is child is a residen

t of zip

code 2

29

01

, 22

90

2 o

r 22

90

3.” _____________________________________________________

s

ign

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FO

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LY: D

ate Received: _____________________

G

rou

p Co

de: ____________–_______________________

The Rotary Club of Charlottesvillec/o The Charlottesville Area Community Foundation P.O. Box 7302 Charlottesville, VA 22906 (434) 293-9104, ext. 103

The Rotary Club of Charlottesvillec/o The Charlottesville Area Community Foundation P.O. Box 7302 Charlottesville, VA 22906 (434) 293-9104, ext. 103