READ ACROSS AMERICA Parent SURVEY 2016
RequiredRequired Question(s)


We are very excited that you have CELEBRATED READ ACROSS AMERICA with us. 


Complete this survey by April 4th!  The first 10 children will receive a free children's book and all will receive a bookmark and an "I Love Reading" bracelet!


*Please fill out all of the information below. 


 
Required 1.

Please enter the information indicated below.




First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:
Names and DOB of Children in Family:

Required 2.

Check off the Activities that you did with your child(ren) 


Activity #1: Imaginary Perfect Pet
Activity #2: Animal Shelter: What Pet Would You Get?
Activity #3: Bird in a Cage
Activity #4: Read to an Animal (real or stuffed)
Activity #5: One Fish, Two Fish....Art Activity
Activity #6: One Fish, Two Fish....Snack Activity
Activity #7: Itsy Bitsy Pets Book
Activity #8: What Pet Should I Get? Guessing Game
Other  
  • Comment:

  • 500 characters left.