Rep. Moore’s Summer Reading Program

Reading List Submission Form

Student's Name(Required)

First Last

Student's Grade in the Fall(Required)

Parent/Guardian's Name(Required)

First Last

Parent/Guardian's Phone

Parent/Guardian's Email(Required)

Parent'Guardian's Address(Required)

Street Address City State ZIP Code

Parent/Guardian Verification of Reading(Required)

I verify my student has read the following 8 books over the summer:

Book 1(Required)

Book 2(Required)

Book 3(Required)

Book 4(Required)

Book 5(Required)

Book 6(Required)

Book 7(Required)

Book 8(Required)

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