Books Beginning at Birth Application Form

Books Beginning at Birth

If you live in Texas and have children aged 4 and under then you can sign up to receive free books and resources mailed to you. Supplies of print books are limited but digital books are always available in the Digital Library.
I have watched the video and pledge to read to my child every day.*

YesNo
Select your zip code or choose "my zip code is not listed." *
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
What county in Texas do you live in?*
Phone Number
Please enter a valid phone number.
E-mail*
example@example.com
Would you like to receive information from BookSpring about reading at home? We will use your email address to send information to you.*

YesNo
Do you receive or qualify for financial assistance through governmental programs, such as WIC or SNAP?*

YesNo
How did you hear about this program?*

Social MediaRadio or TelevisionSchool or ChildcareBillboards or FlyersFriends or NeighborsOther
First child
When was your first child born?*

MonthDayYear
Date
What is your first child's name?
What gender is the first child?*

MaleFemaleNon-binaryPrefer not to say
What ethnicity does the first child identify as?*

African AmericanWhiteAsian or Pacific IslanderHispanicAmerican IndianTwo or more races
What language would you like for the first child?*

EnglishSpanishBoth
What topics interest the first child?*

Funny/silly storiesAnimalsMake believeStories about peopleAdventuresNon-fictionMysteriesAll of the above
Do you want to add a second child?*

YesNo
Second child
When was your second child born?

MonthDayYear
Date
What is your second child's name?
What gender is the second child?*

MaleFemaleNon-binaryPrefer not to say
What ethnicity does the second child identify as?*

African AmericanWhiteAsian or Pacific IslanderHispanicAmerican IndianTwo or more races
What language would you like for the second child?*

EnglishSpanishBoth
What topics interest the second child?*

Funny/silly storiesAnimalsMake believeStories about peopleAdventuresNon-fictionMysteriesAll of the above
Do you want to add a third child?*

YesNo
Third child
When was your third child born?

MonthDayYear
Date
What is your third child's name?
What gender is the third child?*

MaleFemaleNon-binaryPrefer not to say
What ethnicity does the third child identify as?*

African AmericanWhiteAsian or Pacific IslanderHispanicAmerican IndianTwo or more races
What language would you like for the third child?*

EnglishSpanishBoth
What topics interest the third child?*

Funny/silly storiesAnimalsMake believeStories about peopleAdventuresNon-fictionMysteriesAll of the above
Confirmation
I confirm that I am the parent/caregiver of the child(ren) listed in this application and/or that I have permission from the parent/caregiver to share this information with BookSpring.*

YesNo
Should be Empty:

Books Beginning at Birth

First child

Second child

Third child

Confirmation