Buchanan County Public Library

Imagination Library Sign Up Form

Dolly Parton’s Imagination Library Official Registration Form (one per child required)

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

Please Print

Preschool Child’s Full Name                                                                                                                                              

Child’s Date of Birth            /              /                  Sex:  M    F     Phone                                                                           

Parent/Guardian’s Name                                                                                                                                                      

Child’s Home Address                                                                                                                                                           

                                                                                                                                                            

Mailing Address (If Different)                                                                                                                                                

                                                                                                                                             

*This Child is a resident of Buchanan County*  (Signature)                                                                                       

FOR OFFICE USE ONLY:     Date Received                                           Group Code                           –                       

 

  • Hours

    Mon: 1pm-8pm
    Tues-Wed: 8:30am-5pm
    Thu: 8:30am-8pm
    Fri-Sat: 8:30am-5pm
    Sun: Closed

  • Get in touch

    276-935-5721

    Fax: 276-935-6292

  • Find us

    1185 Poe Town Street
    Grundy, VA 24614

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