Read to Lead After School Programming 2021-2022
Please fill out this form so our team has all the information to help get your child registered. We will contact you once we have the for submission.
Sign in to Google to save your progress. Learn more
Student Name
Student Date of Birth
MM
/
DD
/
YYYY
Student Grade
Clear selection
What school does your child currently attend?
Does your child have an active 504 or IEP?
Clear selection
What would be helpful for us to know about your child to help them learn best?
Do you have access to transportation or will you need assistance?
Clear selection
Parent/Guardian Name
Parent/Guardian Contact Number
Emergency Contact Information (Name and Phone Number)
I Would Rather Be Reading is a local non-profit organization whose mission is to provide equitable access to literacy instruction, enrichment opportunities, and advocacy. In order to provide affordable programming to families and students, we depend on the generosity of local donors, organizations, and individuals. We are very active on social media,  frequently  posting pictures and videos  to keep donors engaged and to secure continued financial support for programming. Please type your name below to acknowledge your consent for IWRBR to use pictures and videos of your child/ren on any and all social media, website, and marketing materials.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of I Would Rather Be Reading. Report Abuse
Google Forms