Dolly Parton Imagination Library

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Consent for data usage

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 datasets with the information provided herein and share them with research and educational advancement partners. By checking the box and continuing this registration you expressly consent to the terms set forth herein.

Child Full Name

First Name *

Last Name *

Child's Date of Birth

Child's Gender

Male
Female

Child's Mailing Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Child's Birth Hospital

Cape Fear Valley Health
Womack Hospital
Other

Child's Birth Hospital - Other (Please Elaborate)

Parent/Guardian's Full Name

First Name *

Last Name *

Parent/Guardians Email

Parent/Guardians Phone Number

go6trnwoq3se

Language preference

Confirm that the child lives in Cumberland County, NC (DO NOT SUBMIT IF NOT IN CUMBERLAND COUNTY, NC)

Is This For Change of Address

Please add me to the United Way of Cumberland County e-newsletter

Register my Child

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