"Reimagine Readers" Book Club

"Reimagine Readers" Book Club
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Phone Number*
Please enter a valid phone number.
Address*

Stret Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child School*
Child Name*

First NameLast Name
Child Age*
What are your aspirations for your students as they join this club?*
Media Release Consent:

By joining our bookclub, I give permission for photos or videos of my child participating in book club activities to be used by Re-imagine Communities for promotional and educational purposes, including but not limited to print, online, and social media. I understand that my child’s name or personal information will not be shared without additional consent.

I acknowledge that I will not receive compensation for the use of these images or recordings and that I waive any right to inspect or approve the final materials. I also agree not to hold Re-imagine Communities liable or pursue legal action for the use of these photos or videos.
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