[mk_page_section bg_image=”https://cytrynspeech.com/wp-content/uploads/2019/05/lisa-kid-reading-2.jpg” bg_color=”rgba(123,123,123,0.48)” blend_mode=”multiply” bg_repeat=”no-repeat” bg_stretch=”true” video_opacity=”0.9″ padding_top=”0″ padding_bottom=”140″ sidebar=”sidebar-1″][vc_column][mk_padding_divider size=”160″ visibility=”hidden-sm”][mk_padding_divider size=”100″][mk_fancy_title tag_name=”h5″ color=”#ffffff” size=”24″ line_height=”90″ font_weight=”400″ txt_transform=”uppercase” margin_bottom=”0″ font_family=”Poppins” font_type=”google” align=”right”][/mk_fancy_title][mk_fancy_title tag_name=”h1″ color=”#ffffff” size=”56″ force_font_size=”true” size_tablet=”45″ line_height=”95″ font_weight=”bold” txt_transform=”uppercase” margin_bottom=”0″ font_family=”Poppins” font_type=”google” align=”right”]summer reading groups registration[/mk_fancy_title][/vc_column][/mk_page_section][vc_row][vc_column][mk_padding_divider size=”50″]

Child's name:*
Gender:
Date of birth:*
MM slash DD slash YYYY
Child's phone number (if applicable):
Grade:*
School:*
Home mailing address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent 1 name:*
First Last
Parent 1 phone number:*
Parent 1 email:*
Parent 2 name:
First Last
Parent 2 phone number:
Parent 2 email:
Languages spoken at home (specify primary language):*
Does your child have a hearing loss?
Tell me about your child's reading level:*
Do they enjoy reading?
Do they mix up words that look alike or have similar meanings?
Does your child have difficulty with little words, such as "the, of, said"?
Does/did your child have difficulty with rhyming or learning the alphabet?
Does your child have any behaviour or attention issues at school?
Form completed by:*
Today's date:*
MM slash DD slash YYYY

[/vc_column][/vc_row][mk_page_section bg_color=”#ffffff” border_color=”#ffffff” bg_repeat=”no-repeat” padding_top=”0″ padding_bottom=”40″ sidebar=”sidebar-1″][vc_column][mk_padding_divider size=”30″][/vc_column][/mk_page_section][mk_page_section bg_color=”#b7a18c” border_color=”#ffffff” bg_repeat=”no-repeat” padding_top=”40″ padding_bottom=”40″ sidebar=”sidebar-1″][vc_column][mk_fancy_title tag_name=”h4″ color=”#ffffff” size=”48″ force_font_size=”true” size_tablet=”30″ size_phone=”14″ font_weight=”400″ txt_transform=”none” margin_top=”15″ margin_bottom=”0″ font_family=”Poppins” font_type=”google” responsive_align=”left”]Receive tools and insights for better communication[/mk_fancy_title][mk_button dimension=”outline” corner_style=”rounded” size=”medium” url=”http://eepurl.com/conmYP” align=”center” margin_bottom=”0″ margin_right=”0″ outline_skin=”custom” outline_active_color=”#ffffff” outline_active_text_color=”#ffffff” outline_hover_bg_color=”#dc661e” outline_hover_color=”#ffffff”]YES, SIGN ME UP! [/mk_button][/vc_column][/mk_page_section][mk_page_section bg_image=”https://cytrynspeech.com/wp-content/uploads/2016/06/CS-OPT-0028.jpg” bg_position=”center top” bg_repeat=”no-repeat” bg_stretch=”true” video_color_mask=”#000000″ video_opacity=”0.3″ padding_top=”70″ padding_bottom=”40″ sidebar=”sidebar-1″][vc_column][vc_column_text margin_bottom=”5″][/vc_column_text][mk_fancy_title tag_name=”h3″ color=”#ffffff” size=”60″ force_font_size=”true” size_tablet=”40″ size_phone=”20″ margin_top=”15″ margin_bottom=”0″ font_family=”Poppins” font_type=”google”]Testimonials[/mk_fancy_title][mk_testimonials style=”simple” skin=”light” count=”-1″ slideshow_speed=”11500″][/vc_column][/mk_page_section]