Beyond The Table Book Club Registration

Beyond The Table Book Club Registration

The book club helps girls ages 10-18 further develop their goal settings and leadership skills but also explore their voice and personal autonomy through innovative activities focused on Self Esteem, Public Speaking and Character Building. The curriculum is custom designed by Department of Education certified professionals who utilize Digital Media, ELA and History to present a holistic and culturally relevant learning experience. The books will be provided through our new partnership with Scholastic as Scholastic Literacy Partners.
Student's Name (First, Last) *
Pronunciation of Name
Preferred Pronouns *
Date of Birth *

Month Day Year
Current City *
Current State *
Please list your current country if applying from outside of the United States
Background/Ethnicity *

Black Black/African-American Caribbean/Caribbean American Hispanic/Latinx Asian (including South Asian, Indian) Native Hawaiian or Other Pacific Islander White Other
T-Shirt Size *
I would describe myself as *

Extremely Shy Shy until you get to know me Outgoing
Name of current academic institution *
I'm currently in *
The book I'd prefer to read is *

Jada Jones Sky Watcher (Recommended for readers 8-10 years old) Love Like Sky (Recommended for readers 11-13 years old) This Side of Home (Recommended for readers 14-17 years old)
My preferred learning style... *

Visual- I prefer to see pictures, videos, charts, graphs and power points. Auditory- I prefer to read aloud, hear videos, have discussions, receive verbal instructions and repeat things for clarity. Kinesthetic - I prefer hands-on-activities. Reading/Writing- I prefer to take notes, read the instructions for myself and read books for further understand.
What's your favorite book and/or book series?
Student's Name (First, Last)
Pronunciation of Name
Preferred Pronouns
Date of Birth

Month Day Year
Background/Ethnicity (you may select more than one)

Black/African-American Caribbean/Caribbean American Hispanic/Latinx Asian (including South Asian, Indian) Native Hawaiian or Other Pacific Islander White Other
T-Shirt Size
I would describe myself as

Extremely Shy Shy until you get to know me Outgoing
Name of current academic institution
I'm currently in
The book I'd prefer to read is

Jada Jones Sky Watcher (Recommended for readers 8-10 years old) Love Like Sky (Recommended for readers 11-13 years old) This Side of Home (Recommended for readers 14-17 years old)
My preferred learning style...

Visual- I prefer to see pictures, videos, charts, graphs and power points. Auditory- I prefer to read aloud, hear videos, have discussions, receive verbal instructions and repeat things for clarity. Kinesthetic - I prefer hands-on-activities. Reading/Writing- I prefer to take notes, read the instructions for myself and read books for further understand.
What's your favorite book and/or book series?
Name of Parent, Caretaker, Guardian (First, Last) *
Relationship to Student(s) *
Current Mailing Address (Where we will send book/activity box for the remainder of 2021) *
Please include any apartment or P.O. Box numbers.
Preferred Email Address *
Preferred Telephone Number *
Please list an additional emergency contact name and phone number. *
Has your student(s) participated in a Dinner Table program before? *

Yes No
My child/children is/are participating in The Dinner Table's program with my consent. I grant The Dinner Table the right to use, reproduce, assign, and/or distribute photographs, films, videotapes, and sound recordings taken of my child during the program. The materials may be used for online, interoffice, public marketing or training purposes or by media sources reporting on The Dinner Table's activities. *

Yes No Other
Will your student(s) be available to participate during the program dates listed above? *

Yes No Other
Please confirm how many students will be participating in the Beyond The Table Book Club program. *
STUDENT: Please initial here that you have read and understood all of the information above and certify that all of the information shared in this application is true and correct to the best of my knowledge. *
PARENT/GUARDIAN: Please initial here that you have read and understood all of the information above and certify that all of the information shared in this application is true and correct to the best of my knowledge. *
My Products *
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