Summer Reading Registration
June 3-June 28, July 1-31
The Reading Center Location of your choice
337-849-1699, thereadingcenters.com,
Sign in to Google to save your progress. Learn more
Email *
Prevent Summer Learning Loss!
Student's full name *
Primary phone number *
Secondary Emergency contact number *
School Name *
Grade level *
Parent #1 Name *
Parent #2 Name
Primary address *
Location *
Plan option *
A tuition contract must be signed for June and July to secure the spot .
Clear selection
Payment agreement
Clear selection
Contact me to submit banking information.
Clear selection
Does your child have a current diagnosis, IEP, or 504 plan *
Has your childs hearing vision been checked in the last two years?
Clear selection
Has your child's vision been checked in the last two years?
Clear selection
What are your concerns about your child's reading? *
Current Reading or Language Grades
Clear selection
Tell us more, what would you like us to know ?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy