Registration

When you register for the Mentored Readers Book Club, we will mail your subscription package to your home address. Please complete the registration form below to begin.

Agree

Full Name (parent/guardian) *

Email *

Phone Number

Street Address: *

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City

Postal Code/ZIP

Province/State

Country

Full Name (child/teen)

Gender

Date of birth

Choose a Program

Select child's reading level

Select child’s grade level

What is your goal for signing up (Child’s name):

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How did you hear about us?

Media Release: We take pictures and record videos of our Book club activities and book reviews. By signing this form, you give us permission to utilize any pictures or videos of your child for archive and promotional marketing purposes only. Confidentiality: We will handle your/your child's personal information with the utmost confidentiality and will not disclose it to any third parties. *

Agree

Consent for Future Contact: By agreeing to this disclaimer, you grant us permission to contact you/your child in the future regarding other program-related activities.

User Password *

Confirm Password *

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