New Worlds Reading

Enrollment Form

Family/Caregiver
and Child Info

1

Book
Interests

2

Shipment
Address

3

Complete the form below for your eligible student to receive a FREE book in the mail each month during the school year! Once you review and submit, you will be given the option to enroll additional eligible students.

Book delivery will begin 6-8 weeks after completing this enrollment form. Please double-check to make sure all information is correctly entered so that shipping is not delayed.

All information is required unless otherwise indicated.

Family/Caregiver Name and Contact Information

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This field is required.

A phone number or email address is required.

Please enter a valid email address.

Please enter a phone number in a valid format.

Student Information

This field is required.

This field is required.

This field is required.

This field is required.

This field is required.

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Select your child's top THREE favorite types of books:

Please select 3 book categories.

Select your preference for specialized book titles. When available, you will receive books based on your preference:

Select at least one specialized book title.

Shipment / Mailing Address

This field is required.

This field is required.

This field is required.

This field is required.

Please check the box to agree to the enrollment terms and conditions.

Validate Your Address

Choose the address suggested below to ensure an accurate delivery.

Confirm Your Address

We couldn't verify the exact address you entered. Please double check to confirm it's correct or make any necessary changes.

Address
City, State
Zip

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