Student Registration FormPlease fill out this form if you have not already done so. Child's Name * First Name Last Name Guardian's Name * First Name Last Name Child's Birth Date * mm/dd/yyyy Child's Grade * Email * Best email to reach you Phone * Best number to reach you (###) ### #### Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Has your child been diagnosed with dyslexia? * Yes No Is your child in Structured Literacy? * Yes No Thank you for submitting this form! We’re so excited to have your child in the ReaDefy community!
