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6. Action Club is open to anyone who would like to participate, regardless of residency within Shady Shores, TX. We plan to set up monthly Facebook Events to engage members to participate from anywhere.
8. Participant First Name
9. Last Name
11. Street Number
12. Street Name
13. City
14. State
16. Zip
17. Email Address*
18. Contact Phone Number
20. Age Range

    1. 0-Kinder
    2. Elementary
    3. Junior/Middle School
    4. High School
    5. Adult- Young/Middle
    6. Senior

    This helps us plan books and activities to meet many multi-generational members. 

21. I would be willing to help:

    1. books to read
    2. activities
    3. discussion questions
    4. gatherings
    5. other ideas

    If you would be willing to help organize and coordinate our program along side staff please indicate which areas: 

23. Parent/Guardian First Name
24. Last Name
26. Social Media Consent/Release Statement

    
    

    Social Media Consent/Release Form For News Media, Promotional Materials, Written Articles, Research and/or Photographs 

    By submitting this form:

    I hereby authorize the Town of Shady Shores to use my photo and/or information related to my experiences with Action Book Club and/or Town of Shady Shores. I understand this information may be used in publications, including electronic publications, audiovisual presentations, promotional literature, advertising, community presentations, letters to area legislators and media and/or other similar ways.  My consent is freely given as a public service without expecting payment. I release Town of Shady Shores and their respective employees, officers and agents from any and all liability which may arise from the use of such news media stories, promotional materials, written articles, videotape and/or photographs.  I understand that I can revoke this release any time in writing and that the use of any of my photos or other information authorized by this release will immediately cease. 

    
    

    
    

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field