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Family Reading Partners Enrollment
Your Full Name
(Required)
Street Address
(Required)
City
(Required)
Zipcode
(Required)
Email Address
(Required)
Phone Number
(Required)
Does your child receive free or reduced lunch or is eligible for Medicaid?
(Required)
Yes
No
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
Do you feel comfortable receiving services in English, or would you prefer an interpreter?
I am comfortable with English
I need an interpreter
School Aged Child Information
Please fill in the information for your child in Kindergarten or higher.
Child Name
(Required)
Child Date of Birth (Month, Day, Year)
(Required)
Child's Gender
Male
Female
Prefer Not to Say
Child's Teacher (24-25 school year)
(Required)
Child's Grade Level (25-26 school year)
(Required)
Child's School (25-26 School Year)
(Required)
Younger Child Information
Please fill in the information for you child aged 4 or younger.
Child Name
(Required)
Child Date of Birth (Month, Day, Year)
(Required)
Child's Gender
Male
Female
Prefer Not to Say
Do you have additional School Aged Children in the Home?
(Required)
Yes
No
Child Name
Child Date of Birth (Month, Day, Year)
Child's Gender
Male
Female
Prefer Not to Say
Child Grade Level and School
Child Name
Child Date of Birth (Month, Day, Year)
Child's Gender
Male
Female
Prefer Not to Say
Child Grade Level and School
Do you have additional children 4 or younger in the home?
(Required)
Yes
No
Child Name
Child Date of Birth (Month, Day, Year)
Child's Gender
Male
Female
Prefer Not to Say
Child Name
Child Date of Birth (Month, Day, Year)
Child's Gender
Male
Female
Prefer Not to Say
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