RTO – Test Form Reading Together Online - Student Application * indicates a required field Student InformationToday's Date - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Student's Full Name * RequiredParent or Guardian's First Name * RequiredAddress * Required Street Address City State ZIP Code Phone Number * RequiredWork/Cell PhoneEmail Student's Date of Birth - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Student's Grade in School1st2nd3rd4th5thStudent's School * RequiredPreferred Times * Required1-7 Monday1-7 Tuesday1-7 Wednesday1-7 Thursday1-7 Friday1-4 weekendsSuggest Other TimeRace/Ethnicity/Cultural Group/Gender (OPTIONAL)Check all that apply: American Indian Alaska Native Asian Hmong Cambodian Vietnamese Karen Black or African American Somali Nigerian Oromo Ethiopian Hispanic or Latino Native Hawaiian or Pacific Islander White or Caucasian Multiracial Other Race Language spoken at homeStudent's GendermalefemaletransgenderParent ResponsibilitiesParent Responsibilities * RequiredI understand my responsibilities as a parent of a Reading Together student and agree to follow the policies. Reading Together is a weekly commitment, and my child is expected to attend each week and be at the library on time. If my child is unable to attend due to illness or an emergency, I will call the library to report the absence. Too many absences may result in removal from the program. I am responsible for my child’s transportation to and from the library and will remain in the library during the tutoring. I understand that space is limited and that many families would like to participate in the program. Completing an application does not guarantee a spot in the program for my child. YesNoCommentsThis field is for validation purposes and should be left unchanged. Close Can you tell me more about this webform submission? The contents of this webform are sent to library staff via email. We recommend that you do not submit confidential information (like your library card number, passwords or credit card information). If you need to share confidential information with library staff, we suggest that you use other channels of communication, such as the telephone.Visit our Privacy Statement, opens in a new window, opens a new window to learn more about how your personal information is handled and protected. This information will be submitted via email. Learn More about sending data over email. This iframe contains the logic required to handle Ajax powered Gravity Forms.