Reading Pals Application | Boulder Public Library

Reynolds Reading Pals – Little Pals Application

Summer Session, June 4 - August 3, 2013
(excluding the week of July 1 - 6)

Reynolds Reading Pals is a program intended to promote literacy skills and a love of reading for children in early elementary school in a comfortable and supportive environment. This program provides stimulation that comes from receiving special attention from a high school student while also having fun. Reading Pals is open to children in grades K-3. Each little pal will be paired with a big pal.

Space is limited. Little Pals will be assigned on a first come, first served basis. The Library will keep a short waiting list for each season’s program.

Child's Name*

First Name

Last Name

Gender*

Male Female

Age*

program is open to grades K-3

Grade*

Parent / Guardian's Information

Name*

First Name

Last Name

Address*

City

State

Zip Code

Primary Phone*

Secondary Phone

Email*

How did you hear about Reynolds Reading Pals?

Scheduling

Which days and times work best for your child? Choose one.*

Tuesday afternoons from 4:30 to 5:30 Saturday afternoons from 4:30 to 5:30 No preference (A match will be made for the day with the most space available)

If your child is assigned, mark each date to indicate your commitment to attend:

Big Pal Matching Information

The following information helps us select the best Big Pal for your child.

I would prefer my child to have a Big Pal who is a *

Male Female no preference

subject to availability

What language(s) does your child speak at home? *

My child's reading is*

below grade level at grade level above grade level not sure

My Child is:*

Shy Outgoing Somewhere in-between

My child's interest*

My child's favorite books:*

I would like my child to participate in Reynolds Reading Pals because: *

What else would you like us to know about your child?

Finalizing Your Application

Please read the following statements and mark the check box below.

I know that sending this form does not guarantee placement in the Reading Pals Program and that placement is first come, first served.

I am aware of the dates of the program. I will notify the Library well in advance if my Little Pal cannot attend because I know that the Big Pals have made a time commitment to my child. I will arrive on time for every session.

I am aware that if my Little Pal misses more than two sessions, that his/her Big Pal will be assigned another Little Pal from the waiting list.

I agree to abide by the Library Rule that “no child under age 11” will be left unattended in the Library. I do not expect either the Big Pal or the Library to be responsible for my child.

* I have read and understand the above statements.

Photo Release

Check this Photo Release Statement only if you approve: I give Boulder Public Library permission to publish in print, electronic, or video format the likeness or image of my child. I release all claims against the Library with respect to copyright ownership and publication, including any claim for compensation related to the use of the materials.

Check this Photo Release Statement only if you approve

Reynolds Reading Pals – Little Pals Application

Parent / Guardian's Information

Scheduling

Big Pal Matching Information

Finalizing Your Application

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