Getting Started Please complete the form below to get in touch: Parent/Guardian Name * First Name Last Name Child's Name First Name Last Name Child's Date of Birth MM DD YYYY Email * Phone * (###) ### #### Address Details * Describe concerns about your child's literacy skills and/or questions you have. Preferred Service Location: (select all that apply) Virtual Your home in Hamilton Community location in Hamilton Preferred contact method to schedule the first appointment: By selecting a contact method, you consent to being contacted by a staff member of Future Bookworm. Email Phone Call Text Message Consent Upon providing my consent, a client profile will be created in the electronic medical records system of Future Bookworm (Jane App). I consent to creation of a client profile. Thank you for your submission! You are now on the path to reduce your child’s frustrations with reading and writing - one step at a time! You will be contacted within 2 business days via your preferred contact method. If you do not receive a message within that timeframe, please reach out to hello@futurebookworm.com to connect.