Reading Club

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Reading Club

Mondays 4:30-6:30pm

Child Name

Grade beginning Fall 2026 *

1st

2nd

3rd

4th

5th

My Child:

Loves Reading and it comes pretty easily to them.

Loves reading but it is a challenge at times

Is ok with reading, but prefers other activities

Struggles with reading compared with other children their age

Other:

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Parent/Guardian Name *

Parent/Guardian Phone #

Other Emergency Contact Name & # *

Please describe any Allergies, Health Concerns, Behavioral Concerns *

My child would need transportation in order to attend. (limited spaces available) *

Yes

Address: (Please provide if you are requesting transportation)

I understand that I will need to sign a permission waiver for my child to participate and/or receive transportation. *

Yes

Required

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