Enrollment

Enrollment Form

Family/Caregiver
and Child Info

1

Book
Interests

2

Shipment
Address

3

Please enter your child's information, including the school and grade for the upcoming 2022-2023 school year, in the enrollment form below. All information is required unless otherwise indicated.

Once you review and submit, you will be given the option to enroll additional eligible students.

Family/Caregiver Name and Contact Information

First Name

This field is required.

Name must be between 2 and 30 characters.

Field cannot contain special characters.

Last Name

This field is required.

Name must be between 2 and 30 characters.

Field cannot contain special characters.

A phone number or email address is required.

Email

Please enter a valid email address.

Phone Number

Please enter a phone number in a valid format.

Student Information

Legal First Name No nicknames or abbreviations

This field is required.

Name must be between 2 and 30 characters.

Field cannot contain special characters.

Legal Last Name No abbreviations

This field is required.

Name must be between 2 and 30 characters.

Field cannot contain special characters.

Date of Birth month/date/year

This field is required.

Grade Level (- School Year) Grade Level (School Year -)

This field is required.

Gender

This field is required.

Ethnicity

This field is required.

Race

This field is required.

District (- School Year) District (School Year -)

This field is required.

School Name (- School Year) School Name (School Year -)

This field is required.

FLEID (optional)

Student's School ID (optional)

Shipment / Mailing Address

Street Address

This field is required.

Apt/Suite/etc (optional)

City

This field is required.

State

This field is required.

Zip Code

This field is required.

That combination of city, state, and zipcode do not match any known addresses. Please edit and try again.

I agree to the terms and conditions

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

I affirm that the information provided is correct to the best of my knowledge and my child is not yet reading on grade level. I understand that any errors in the provided information may prolong the eligibility verification process and may require the form to be filled out again.

Please check the box to confirm you have provided accurate information.

Check Address and Submit

Validate Your Address

Choose the address suggested below to ensure an accurate delivery.

Suggested Address

Address

City,State

Zip

Original Address

Address

City, State

Zip

Use this address

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

Edit Address

save and continue

Validate Your Address

We couldn’t verify the address you entered. Did you mean this address?

Address

City,State

Zip

Use This Address

Edit Address

Enrollment Form

Family/Caregiver
and Child Info

Book
Interests

Shipment
Address

Family/Caregiver Name and Contact Information

A phone number or email address is required.

Student Information

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

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

Shipment / Mailing Address

Validate Your Address

Confirm Your Address

Validate Your Address

Enrollment Form

Family/Caregiverand Child Info

BookInterests

ShipmentAddress

Family/Caregiver Name and Contact Information

A phone number or email address is required.

Student Information

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

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

Shipment / Mailing Address

Validate Your Address

Confirm Your Address

Validate Your Address

Family/Caregiver
and Child Info

Book
Interests

Shipment
Address