Bookworm Friends Participation Form

Date*

Adult's Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code

Day Phone #*

Evening Phone #

if different from above

Email*

Where did you hear about Bookworm Friends?*

Check any that apply.

If you answered other, where did you hear about us?

I am:*

What grade do you teach?*

What age is your child/children?*

Do you prefer online or in-person (e.g. libraries/schools)?*

I use video chat technology:*

Training is available.

What device will you use to participate if you prefer the online option?

Reading will usually be once a week. When are you and your child/children available?*

Select all that apply.

How interested does your child seem when being read to?*

What date can you start?*

What information might be helpful for us to know?

Bookworm Friends