Reading Doctor's Prescription (Book Club)
Please fill in the information below. Once submitted, I will contact you within a few days for credit card information and to discuss further any preferences. You will start receiving your books the month following submission of the form.
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Child's First and Last Name *
Your answer
Parent Email *
Your answer
Mailing Address -street name *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Child's Interests, Hobbies, Activities *
Your answer
Child's Favorite Books *
Your answer
Your favorite kid's book (either as a child or currently) *
Your answer
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