Name

First
Last
Birthday

MM 		/
DD 		/
YYYY
 Boy 
 Girl 
Phone Number

### 		-
### 		-
####
Email (if you're under 13 we need your parent/ guardians email address)
Tell us why you like to read

*If you are under 13 we will send an email to
your parent/guardian requesting permission for
you to join the club.

**The monthly "Read to Me Rapper" will only be
featured with parent/guardian permission.