Reading Doctor's Prescription (Book Club)

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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 *

Parent's Last Name *

Child's First and Last Name *

Parent Email *

Mailing Address -street name *

City *

State *

Zip Code *

Child's Interests, Hobbies, Activities *

Child's Favorite Books *

Your favorite kid's book (either as a child or currently) *

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