Application for Kidsmobile Service

* indicates required field

Part A - Contact Info

*Name of Organization:
Address of Organization:
Cross Streets:
*Name and Title of Contact Person:
*Email:
*Phone Number:

Part B - Kidsmobile Use

Please select how the Kidsmobile will be used: school, special event, or other.

School District:
*Reading Score Rank:
Closest BPL branch: View Map
*Barriers to Local Library:
*Number of classes expected: (include grade levels)
*Location to park kidsmobile: (include cross streets, 2 adjoining parking spaces are required)

Special Event:
Location:
*Time and Date of Event:
*Number of children expected:
*Location to park kidsmobile: (include cross streets, 2 adjoining parking spaces are required)

*Type of Organization:
*Number of children expected:
*Location to park kidsmobile: (include cross streets, 2 adjoining parking spaces are required)