READER REGISTRATION Palm Beach Gardens Store
11262 Legacy Ave, PBG, FL 33410 (OFF PGA BLVD in PBG)
Tell Us Who'll Be Reading
(limited to one child/reader per registration)
Reader (Child) Name
*
First Name
Last Name
Reader (Child's) Age
*
Is The Reader (Child) Dyslexic?
*
Yes
No
Parent / Guardian Contact
You'll Receive Confirmation To The Email You Provide Below
Parent or Guardian Name
*
First Name
Last Name
Parent / Guardian Email
*
yournname@example.com
Parent / Guardian Mobile Number
*
-
Area Code
Phone Number
Save A Spot For Me!
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