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READ Kit Request Form
Use this form to request a READ Kit. Check out time is 3 weeks.
Questions? Email us at CHSYouth@anixter.org or call (312)523-6400.
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Borrower Name
*
Your answer
Borrower Address
(street, apartment number, city, state, zip code)
*
Your answer
Borrower Phone
Your answer
Age of Deaf, DeafBlind, or Hard of Hearing Child
*
Your answer
Borrower Relationship to DDBHH Child
*
Parent/Caregiver
Professional Provider/DTH
Other:
Which READ Kit would you like to borrow?
*
Animals Kit: Brown Bear, Brown Bear, What Do You See/ 100 First Animals
Bedtime Kit: Good Night Moon/ Bedtime
Doctor Kit: First Time Doctor/ If I Were a Doctor
Food Kit: Mealtime/ Eat the Rainbow
My Body Kit: Head to Toe/ Head, Shoulders, Knees, and Toes
Peek-a-Boo Kit: Peek-a-Who/ Peek-a-Zoo
Spot the Dog Kit: Where's Spot/ Spot Goes to the Park
Transportation Kit: My First Things That Go/ DK Things That Go
A copy of your responses will be emailed to the address you provided.
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