Prime Time Family Reading Time Sign up

2. Parent First Name

3. Parent Last Name

5. Address1

7. Address2

9. City

10. State

11. Zip

13. Telephone number

14. Email Address

16. I plan on attending Prime Time with my child (children)

    1. Yes
    2. No

18. Child name

19. Date of Birth

20. Male/Female

    1. Male
    2. Female

22. Child name

23. Date of Birth

24. Male/Female

    1. Male
    2. Female

26. Child Name

27. Date of Birth

28. Male/Female

    1. Male
    2. Female

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field