Assist-a-Reader Enrollment Form

Seedlings’ Assist-a-Reader Program

The Assist-A-Reader program allows children with vision loss ages 0-21 in Michigan, Illinois, Indiana, Ohio, Minnesota, Wisconsin, and Iowa to receive 10 FREE braille books of their choice, each calendar year! All you have to do is fill out this form and we will match your child with one of our donors.

Please select 12 book choices from Seedlings’ catalog and 10 books from your list of choices will be sent once your child is matched with a sponsor. Please choose books and educational aids only!

Please fill out this form completely. Please be sure to upload a photo of your child. Please note, you must live in one of the above states to be eligible for this program.

*No 3-volume or 4-volume books, please.* For your book choices, please see our at catalog: www.seedlings.org

Child's First and Last Name

Only first names will be used.

Child's Date of Birth

& Book &

Tell us a little bit more about your child

Ex: Family, pets, favorite books, hobbies/interests.

Please upload a photo of your child!

Drag & Drop Files, Choose Files to Upload

This photo will be used to show our donor the child they assisted.

Full Name of Parents or Guardians

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please note, you must live in Michigan, Illinois, Indiana, Ohio, Minnesota, Wisconsin, or Iowa to be eligible for this program.

Email Address

Phone Number

I, the parent or legal guardian of the child named above, give Seedlings permission to use the above information in promotion of Seedlings’ programs.

Yes. I am the child's parent.
Yes. I am the child's legal guardian.
I have been given permission from the child's parent or legal guardian to submit this form.
No I do not give you permission

Book Choice #1 (Title & Item Number):

Book Choice #2 (Title & Item Number):

Book Choice #3 (Title & Item Number):

Book Choice #4 (Title & Item Number):

Book Choice #5 (Title & Item Number):

Book Choice #6 (Title & Item Number):

Book Choice #7 (Title & Item Number):

Book Choice #8 (Title & Item Number):

Book Choice #9 (Title & Item Number):

Book Choice #10 (Title & Item Number):

Book Choice #11 (Title & Item Number):

Book Choice #12 (Title & Item Number):

I give permission for Seedlings to send me occasional emails.

Seedlings does not share your information

Assist-a-Reader Enrollment Form

Seedlings’ Assist-a-Reader Program

Seedlings Braille Books for Children

Join Our Email List