***PLEASE list one child per survey. Any other names listed in a single survey will be discarded***

* 1. What is your child's first name?

* 2. What is your child's last name?

* 3. What is your name?

* 4. What is your phone number (402 area code assumed), or email address?

* 5. What school grade did your child just complete? If not in school yet, then what is his/her age?

* 6. Is this the first time that you have taken part in our Summer Reading Program?

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