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Teen Takeout Registration Form
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This form has been modified since it was saved. Please review all fields before submitting.
Do you love reading, surprises, and chatting about books? Register below for the Teen Takeout Book Club Kit for personalized book picks and a goody bag that you can pick up at your library's book chat each month! After you submit this form, you'll receive an email with details on when your first kit will be ready at your selected library. Questions? Call the Teen Center at 540-777-8788.
Name
*
Email
*
Phone Number
*
Grade (2023-2024 School Year)
*
-- Select One --
6
7
8
9
10
11
12
Where would you like your book kit sent?
*
Bent Mountain
Glenvar
Hollins
Mount Pleasant
South County
Vinton
How many books would you like per month?
*
1
2
Do you have a library card?
*
Yes
No (If you do not have a card, we will be in touch)
What is your library card number? If you don't know your number, you can provide the name on the account instead.
*
Tell us a little about your favorite books, authors, or series.
*
Tell us a little about your least favorite books, authors, or series.
*
Is there anything we need to know when assembling your bonus bag? Dietary restrictions, items to avoid, etc.
*
Would you like to receive periodic email updates from the teen department?
*
Yes
No
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
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