CELEBRATION BOOK REQUEST FORM

         Date of Birth (or other special occasion): __________________________
 
         Payment enclosed ($15.00):
                                                           ________ Cash _______ Check (payable to Wissahickon School District)
 
 
         I give permission for my child's picture to be put in the book:

                                                          ___________________________ Parent / guardian signature
 

                 Please provide any information which is relevant to selecting a book for your child.

 
      FAVORITE AUTHOR/S:
                                  ________________________________________________
 
 
      FAVORITE ILLUSTRATOR/S:
                                  ________________________________________________
 
 

      SPECIFIC BOOK TITLE:
                                   __________________________________________________