ROCKin' Reading Summer Challenge 2021
Please fill out one form per ELBERT COUNTY FAMILY with your YOUNGEST CHILD (0-5 years) as the main child. You will list other children in the family in the last question.

*Only families with a child 0-5 years are eligible.*

Registering for this program means you will receive free books and tips for encouraging your children to grow their reading skills, and we ask you to complete a weekly "check-in" (2-3 minutes) about reading.

If you have any questions, please contact Laura Evans through either levanscpec@yahoo.com or 706-283-8838.
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1. First name (Adult filling out this form) *
2. Last name (Adult) *
3. Street address (Adult) *
4. City, State (Adult) *
5.  Zip code (Adult) *
6. Email (Adult) *
7.  Phone number (Adult) *
8. Is it ok to text to this number? We we will only contact you with information about the program (about 1 per week) *
9. First name (Youngest child in family) *
10. Last name (Child) *
11. Does the YOUNGEST child live at your same address? If the answer is Yes, skip to #15. If the answer is No or Maybe/Sometimes, go to #12 to list the BEST address for the child. *
12. Street address (Child)
13.  City, State (Child)
14. Zip code (Child)
15. Age (Child) *
16. School attending for 2021-2022 school year (if any) *
17. Grade attending for 2021-2022 school year (if any)
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18. Does your YOUNGEST CHILD have access to reading material at their address (books, magazines, internet, etc.)? *
20. Do other members of your family have access to reading material at their address (books, magazines, internet, etc.)? *
21. Is the YOUNGEST child in your family receiving books from the Dolly Parton Imagination Library (ages 0-5 years)? *
22. Are other children (0-5 years) in your family receiving books from the Dolly Parton Imagination Library? *
23. Please list the names and ages of all other children (17 yrs. or younger) in your family (e.g., Joseph, age 11). If none, write "none". *
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