Registration | Ferst Readers Henry

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Complete the Form Below to Begin Receiving Free Books

Child #1

All information is kept confidential and used only for program registration. You may register up to three children in one submission.

First name*

Last name*

Sex*

Male

Female

Preschool Experience*

Ethnicity*

American Indian

Asian

Black/African American

Hispanic/Latino

White

Other

Date of Birth*

Month

Day

Year

If your child is 5 years old or over, they are not eligable for this program.

Do you have a second child at this address under the age of 5?*

Yes

No

Date of Birth

Address*

Apt/Unit #

City*

State*

Zip Code*

County*

Henry County

Other

Parent/Caregiver

Parent/Caregiver First Name*

Parent/Caregiver Last Name*

Phone Number*

Email Address*

Are you a military veteran?*

Yes

No

Are you someone other than the parent/care giver listed above?*

Yes

No

I certify that this child is under the age of 5 and a resident of Henry county

of Henry County

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HenryCounty@ferstreaders.org
470-236-3332

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