Volunteer Registration

Date:

Name:

Street Address:

,
City, State, Zip

Home Phone:   Cell Phone:

E-mail Address:

If you wish to serve as a Volunteer Reader, federal regulations require a background check. With this background check, we must have your full date of birth. By checking this box, you agree to the required background check. 
Background Check OK

Birthday mm/dd/yy:  

Emergency Contact:

Emergency Phone:

Volunteer Readers

Grade Level Preferences: Please check all grades you will consider

Areas of interests: