Registration: Splash into Reading Virtual Series
                       
                                  ** REGISTRATION FOR THIS PROGRAM IS CURRENTLY FULL.**

Please complete this form to register for the upcoming Splash into Reading Virtual Series.  The registration deadline is June 30, and the program will begin on July 7 using Zoom. You will only need to complete the form once, regardless of how many children you have.

**This program is only available to families who live in Polk and Dallas Counties.  
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Parent/Caregiver Name *
Phone Number *
Mailing Address *
E-mail (optional)
What county do you live in? *
Which session do you plan to attend? *
What language do you prefer to speak?
What is the age of your child?
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Are you comfortable using the virtual videoconferencing platform, Zoom?
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Would you like support before the first session in downloading the app or becoming more familiar with Zoom?
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Gender
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Race
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Ethnicity
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Submit
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