YB&B Book Club Interest Form
Thank you for your interest in the YB&B (Young, Black and Brilliant) readers club! We are thrilled to welcome your child on this exciting journey of discovery and growth. Our program unites a vibrant community of Black and Brown youth to cultivate a love for literature in a positive, supportive environment.
Whether your child is an avid reader or you're encouraging them to pick up books more often, YB&B is the perfect space to inspire a passion for reading while fostering confidence, creativity, and connection. We're so excited to have you join us!

At YB&B, youth meet once a week on Thursdays from 5:45pm - 7:30pm in person to participate in book sessions. Meeting locations are based out of Puyallup, Washington, and may vary depending on the type of event or activity.

Please fill out the form below, and one of our team members will reach out to you for an introductory phone call. Please note that we currently have a waiting list, but we’ll be in touch as soon as space becomes available!

If you have any questions, please email us at Ybnbreadersclub@gmail.com
Sign in to Google to save your progress. Learn more
Email *
Today's Date *
MM
/
DD
/
YYYY
City, State
Parent's Full Name *
Child’s First Name *
Child's Last Name *
Child's Birth Date *
MM
/
DD
/
YYYY
Email address                                                                         *
Phone number *
Gender *
Which category describes your Child ? Select all that apply *
Required
Age *
Current Grade Level *
How did you hear about YB&B Bookclub? *
How many books have your child read in the last 3 month? *
What type of genre of books interest your child? *
Required
Does your child have a library card? *
Required
Does your child have access to a phone, computer, or laptop to attend our Zoom Sessions and reliable transportation to attend our in-person meetings? *
Parents and guardians must volunteer at least 10 hours during the 9-month program, which equals about 1 hour per month. Can you commit to? This may include being a greeter, setting up for sessions, chaperone for fieldtrips, fundraising
 *
Your goal for having your child join the YB&B readers club? *
Parent/child accountability *
Yes, I will remind my child to read the chapters assigned in the readers club
Yes, I will encourage my child to write down and look up the definitions of words they don't know the meaning of
Yes, I will encourage consistent attendance, positive participation and active learning
YB&B asks that parents hold club members accountable for the following:
Please list any allergies your child may have: *
I hereby grant the {YB&B} permission to use my child likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, social media including web-based publications, without payment or other consideration. *
Required
We rely on donations and membership fees from our parents and supporters to keep us active. All contributions help us provide books, supplies, food and snacks, life enrichment activities and covers general operation expenses. Your child’s book club investment: Monthly Fee: $15 Includes: Selected Book- Novel Guide *
Required


Your steadfast commitment fuels our mission to provide essential resources and transformative experiences for our youth. By pledging a monthly contribution of just $15, you become a vital part of our community and enjoy exclusive membership benefits. Your ongoing support directly empowers us to offer books, meals, supplies, and life-enriching activities that shape the future of our youth. Join us on this journey of impact and compassion, knowing that every $15 you contribute monthly creates a lasting difference in the lives of those we serve.
What school will your child be attending for the 2025-2026 school year? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms