Registration Form

Parents or guardians can enroll their child (or children) born in 2008 or later by submitting the short registration form below (one per child). There is no charge or fee required for enrollment. Heart of Missouri United Way will accept donations to offset costs of Imagination Library. The local cost of the program is $30 per child per year.

Parent's Information

Parent Name*

Email Address

Child's Information

Is this child a resident of Columbia, MO?

Yes
No

Child's Name*

Child's Date of Birth (DD/MM)*

Child's Year of Birth

Sex*

Mailing Address*

Mailing Address 2

City*

State*

Zip Code*

County*

Phone Number*

Note:

Books will begin to arrive 8 -10 weeks after registration is received. Please notify us of any change of address. If you have any questions please contact the Sarah Howard at Daniel Boone Regional Library - 573-817-7045

Did your child already receive their first book (The Little Engine That Could) in the hospital?

Yes
No