Readers in Training Enrollment Form

Readers in Training Enrollment Form

*CURRENTLY NOT ACCEPTING NEW FORMS*
Thank you for your interest in our Readers in Training program. At this time, we are currently not accepting any new enrollment applications. Please make sure to visit again in the future for any updates or changes. If you have any questions, please make sure to reach out to us at readersintraining@stwn.org. Thank you!
Readers in Training Enrollment Form

This program is brought to you by Spread the Word Nevada in partnership with PNC Grow Up Great.
Did you know that reading readiness begins at birth? Spread the Word Nevada's new program, Readers in Training (RIT), is making it possible for your young children to join in the fun!
Through this program, we will serve children ages 0-5 and their parents/guardians.

Your child(ren) will receive:
1. New, age-appropriate books mailed to your home monthly
2. Access to online content that focuses on school readiness
3. Monthly virtual check-ins where families can interact 4. Monthly in-person playgroups that will help children develop the skills to become successful students and confident readers
How did you hear about this program?*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Cell Phone Number*

Area CodePhone Number

Contact Information
Parent/Guardian Physical Address (where you can receive packages)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred method of contact (select all that apply)*

Cell PhoneEmailText MesssagesMail
Will you allow STWN to send you text messages?*

YesNo

Connectivity Questions
Do you currently have a Facebook account?*

YesNo
What is your Facebook name?
What type of device will you be using for virtual training sessions?

Smart PhoneTabletLaptopDesktop ComputerOther

Media/Photo Release
I hereby grant Spread the Word Nevada permission to use my name, quotation and/or my likeness in a photograph or video in any and all of its publications, including website entries, without payment or any other consideration.

I understand and agree that these materials will become the property of Spread the Word Nevada and will not be returned.

I hereby irrevocably authorize Spread the Word Nevada to edit, alter, copy, exhibit, publish or distribute this photo and/or my quote or video for purposes of publicizing Spread the Word Nevada’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness or quote appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph, video or quotation.

I hereby hold harmless and release and forever discharge Spread the Word Nevada from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am at least 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
I agree to have my photo taken and used for Spread the Word Nevada marketing purposes*

Yes I do not mind if my photos and/or videos are used to help promote the programNo I would prefer not to use my photos or participate in video footage
My signature affirms that all information is true and correct to the best of my knowledge.*

Clear

Readers In Training Agreement

Please read carefully
As a participant in Readers in Training, I agree to the following conditions to maintain an Active status

1. I will watch all 12 skills based videos presented online.

2. I will actively participate in 6/12 monthly virtual check-in sessions or complete 6/12 check-in questionnaires.

3. I will join and maintain membership in the Readers in Training Facebook group

I understand that failure to complete any of these four conditions will result in my status being changed to inactive and I wll no longer receive books sent home to my child.
Do you agree to the above program requirements?*

YesNo
Signature

Clear

Who should we contact in the event of an emergency?
Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Thank you for the information!

Please hit submit and check your email for confirmation
Should be Empty:

Readers in Training Enrollment Form

Readers in Training Enrollment Form

Tell Us About Your Children

Contact Information

Household Information

Connectivity Questions

Media/Photo Release

Readers In Training Agreement

Who should we contact in the event of an emergency?

Thank you for the information!