Philly Youth Book Club Registration
For teen boys and girls ages 14-17 years old! Register to be one of the first to know when our book club launches in 2024! Philly Youth book club was created to foster a love for reading, promoting thoughtful discussions, and building a sense of community among members! Your child will cultivate a love for reading, improve critical thinking, enhance communication skills, promote social interaction and more!! We're so excited to share this amazing opportunity to learn and grow! Meetings will be virtual with opportunities for in-person meetings!
Parent/Guardian Full Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Email Address
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example@example.com
Parent Phone Number
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Please enter a valid phone number.
Child's Full Name
*
First Name
Last Name
Child's Grade Level
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Child Age
*
Medical Information (if applicable)
Medical Conditions/Allergies & Current Medications
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Permission Granted
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I, the undersigned, grant permission for my child to participate in the Book Club organized by Philly Youth
Date
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Month
-
Day
Year
Date
For Child: Why do you want to join Philly Youth book club? What do you hope to gain?
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Parent Signature
Submit
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