*User Name (First initial, Last name. ex: bjones)
*Password
*
*First Name
*Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
*Gender
*Age
 yr    mo Enter your age as of June 1, 2015
Grade
*Street Address
*Town
*Phone Number
()     - 
*Email
*School Name
*Where did you hear about this summer reading program?
   Please select the best fit from the list.
Are you a Boston Bruins fan?
Yes    No    
*
  Range (21-63) Days