Read

Please fill out this form once you have completed the reading challenge.
Don’t forget you must read atleast 20 minutes a day for 40 days.

Student's Name*
First Last
Students Age
Student Gender
Parent/Guardian Name*
First Last
Parent/Guardian Email*
School Name*
Homeroom Teacher Email
Address*
Street Address Address Line 2 City State ZIP Code
Nearest Public Library Branches*
Date & Minutes Read*
Must read for 20 minutes a day for at least 40 days.
Please press the Plus sign(+) to add more rows
Minimum 40 rows*
DATE MINUTES READ
Total Minutes Read*
Electronic Parent/Guardian Signature or Teacher Name*

START READING TODAY!

DATE	MINUTES READ