Intake form

Help us serve you better

Name *

Email address *

What is your child's age?

What is your preferred method of instruction?

Please select at least one option.

Online

In-person

Hybrid

What specific areas are you looking to improve in your child's reading skills?

Please select at least one option.

Phonics

Comprehension

Fluency

Vocabulary

Motivation

Do you have any prior experience with reading programs?

How did you hear about read at ease?

What are your goals for your child's reading development?

Which service or services are you interested in?

Please select at least one option.

Interactive learning tools

Additional questions or comments

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