Please fill out the following information so we can create an individualized experience that best fits your child.
Student's Name (required)
malefemale
Student's birth date (required)
Grade and school (required)
Is the student on any medication, if so what kind?
Does the student have any allergies, if so to what?
Which age book club are you interested in registering for? Grades 3-5 book club
Parent Name (required)
Address (required)
Phone(required)
Your Email (required)
Emergency Contact (name/number) Please Enter your Credit Card InformationYour card will be charged $200.00.
Credit Card Number Expiration (MM/YY) CVV Billing Zip Code
