Next Chapter Book Club Registration 
Use this form to register for Creative Approach Development Center's Next Chapter Book Club. Once your registration is received, you will be contacted to help the book club leaders learn more about your interests and reading support needs. As a reminder this book club is open to all reading levels so do not hesitate to sign up if you are still working on your reading skills. 
Sign in to Google to save your progress. Learn more
Email *
Book Club Member Name: *
Age: *
Birthdate: *
MM
/
DD
/
YYYY
Address:  *
Phone Number (personal or support persons): *
Email (personal or support person's): *
Emergency Contact Name:  *
Emergency Contact Phone Number: *
Emergency Contact Email Address:  *
What kind of books do you like (choose all that apply): *
Required
If you chose something else, write what it is below: *
The Next Chapter Book Club is perfect for all readers from beginners to those who have read many books. How would you describe your level of reading? *
Which book do you want to read?: *

*IMPORTANT* If you have a medical condition or any self-harm, verbal or physical aggressions that may require immediate attention, your staff, parent, guardian, or the person who brought you to book club must remain on the premises during the meeting. Emergency contact will be called first for any emergencies. 

 

Please read or listen carefully to the following statements:

•        I understand that more than 3 absences within a 3-month period may result in my dismissal from the club in order to allow someone else to attend in my place.

•        I understand that Next Chapter Book Club (NCBC) staff may photograph and/or videotape me and I agree that they may use these photos and/or videos for the purpose of telling other people about NCBC.

•        I understand that I have to follow the guidelines of the NCBC Affiliate and Host facility of the book club

•        I understand that NCBC cannot provide transportation to or from the book club meeting. I will make arrangements to arrive at book club meeting on time and I will be picked up on time.

•        I understand that NCBC volunteers cannot provide one-to-one behavior or medical support and I will bring someone to help me if I have support needs.  I understand that NCBC can ask me to leave the club if my behavior is disruptive, aggressive, or otherwise inappropriate.

.      I understand that there is a $10 fee that needs to be paid to cover the cost of my snacks and materials for the session. 

 *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Creative Approach Development Center, LLC. Report Abuse
Google Forms