READY TO READ
Thank you for your interest in our program. Please give us a little more information and we will reach out to you.
Name
*
First Name
Last Name
Library Barcode (optional)
Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Preferred Library Location
*
Birmingham
Heatherdowns
Holland
Kent
King Road
Lagrange
Locke
Main Library
Maumee
Mott
Oregon
Point Place
Reynolds Corners
Sanger
South
Sylvania
Toledo Heights
Washington
Waterville
West Toledo
Zip Code
*
How many children do you have?
*
1
2
3
4
5
More than 5
Name of Child 1
*
Birthday of Child 1
*
-
Month
-
Day
Year
Date
Grade of Child 1
*
Please fill in for children aged 4 years or older
Name of Child 2
*
Birthday of Child 2
*
-
Month
-
Day
Year
Date
Grade of Child 2
*
Please fill in for children aged 4 years or older
Name of Child 3
*
Birthday of Child 3
*
-
Month
-
Day
Year
Date
Grade of Child 3
*
Please fill in for children aged 4 years or older
Name of Child 4
*
Birthday of Child 4
*
-
Month
-
Day
Year
Date
Grade of Child 4
*
Please fill in for children aged 4 years or older
Name of Child 5
*
Birthday of Child 5
*
-
Month
-
Day
Year
Date
Grade of Child 5
*
Please fill in for children aged 4 years or older
Names, Ages, & Birthdays of Children
*
Child 1: Child 2: Child 3: Child 4: Child 5: Child 6:
For example: 1, 2, 5, 7, 9 ,11
Language(s) spoken in your home
Arabic
ASL
English
Mandarin
Spanish
Other
Interested In
*
Preschool training (for caregivers of children birth to age 5)
Countdown to Kindergarten training (for caregivers of children soon to be entering Kindergarten)
Kindergarten through 3rd grade reading support (for caregivers of children in Kindergarten, 1st grade, 2nd grade, or 3rd grade)
Hosting our group at your event
Please provide more details about your event:
*
Preferred Method of Contact:
*
Phone
Email
Preferred Time of Contact:
*
Morning
Afternoon
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