Children’s Reading Support Application

Which available Children's Reading Support Library is your child applying to?(Required)

Please be sure this matches an available session or your application may not be processed.

Preferred day & time (based on available sessions)

Available sessions are listed on the previous page. Selection isn't guaranteed, but we'll make our best effort to consider based on program availability.

Child's Information

Child's Name(Required)

First Last

Age(Required)

Grade(Required)

School

What language(s) does your child speak?

In what area of study does your child require tutoring?

e.g. Reading, Math, Science, etc.

Medical Information

List any medical conditions, special needs, allergies, (medication, food, etc.) that we should be aware of.

Medical Conditions / Special Needs / Allergies:

Use the + symbol to add additional rows if needed.

Additional Medical Info/Comments:

Parent/Guardian's Contact Information

Parent/Guardian's Name(Required)

First Last

Parent/Guardian's Address(Required)

Street Address Address Line 2 City Postal Code

Phone(Required)

Email(Required)

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Phone

This field is for validation purposes and should be left unchanged.

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Child's Information

Medical Information

Parent/Guardian's Contact Information

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