PROGRAM DETAILS & AGREEMENT
The Lincoln Community Coalition of Nevada (LCC) is pleased to offer the Lincoln County Literacy Enrichment Program to children and youth between the ages of 5 and 18. Participants may choose one (1) book per month from the LCC-provided catalog from the date of enrollment until August 31, 2026.
• Book will be from pre-authorized list of titles.
• Books will be delivered to the mailing address provided above.
• Participation is free of charge.
LCC reserves the right to discontinue or alter this program at any time with written notice.
PARENT/GUARDIAN INFORMATION

Question Title

* 1. Parent/Guardian Name

PARTICIPANT INFORMATION

Question Title

* 2. Full Name of Child/Youth:

Question Title

* 3. Date of Birth: Age:

Question Title

* 4. Mailing Address

Question Title

* 5. City:

Question Title

* 6. Phone (Parent/Guardian):

Question Title

* 8. Age:

Question Title

* 9. State: Zip Code:

PARENTAL CONSENT AND GENERAL LIABILITY WAIVER
By signing below, I, the undersigned parent/legal guardian, give consent
for my child to participate in the Lincoln County Literacy Enrichment Program.
I understand that my child will be receiving books monthly and that it is my
responsibility to ensure the mailing information is accurate and up to date.
I agree to hold harmless Lincoln Community Coalition of Nevada, its
employees, officers, volunteers, and affiliates from any liability, claims,
or demands for personal injury, illness, or property damage arising from
or connected with participation in this program.
I understand and accept that LCC may end this program or modify its terms
at any time with written notice.
Signature___________________________________________________________ Date___________________

T