Family Reading Partners Sign-Up FormIf you live in Orange County, get Medicaid, and have a child under 5 years old, you can join Family Reading Partners.Do you receive Medicaid?(Required) Yes No First Name(Required) Last Name(Required) Street Address(Required) City(Required) Zipcode(Required) Email Address Phone Number(Required) How would you like to be contacted?(Required) Phone Call Text Message Email What is the main language you speak at home?(Required) English Spanish Other Where would you like us to meet you? We meet families in places that are good for them. Here are some ideas: a library, grocery store, University Place Mall, McDonalds, Sheetz, a park or playgroundChild InformationList the names and birthdays of any children living in the home who are 4 years old or youngerChild Name(Required) Child Date of Birth (Month, Day, Year)(Required) Do you have additional children to list?(Required) Yes No Child Name Child Date of Birth (Month, Day, Year) Child Name Child Date of Birth (Month, Day, Year) Child Name Child Date of Birth (Month, Day, Year)