Curriculum-based Program Request Form

Please see program descriptions for more details or contact your local branch at 905-653-READ (7323).
Please note that entries indicated with asterisk (*) are required.

Contact Information

*School/Organization Name:

Grade/Age of Participants:

Number of expected Participants:

*Contact Name:

*Contact Email:

*Contact Phone:

Program Information

(Ctrl + Left Click for Multiple Selections)

*Desired Program: (choose one program)

Closest Location:

Preferred Day of Week for Program:

Preferred Time for the Program:

Comments/Notes:

The personal information collected from you on this form will only be used for the purpose of Curriculum-based Programs. Your personal information will not be shared with outside organizations, except as indicated in the Privacy Statement.

Contact Information

Program Information

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