Ms. Love’s Reading Room Registration Form

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Full Name *

Please enter the full name of the Lovely Learner.

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Age *

Please enter the age of the Lovely Learner.

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Caring Adult’s Name(s) *

Please enter the name(s) of the caring adult(s).

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Caring Adult’s Email *

Please enter a valid email address.

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Phone Number *

Please indicate your preferred method of contact: text, call, or WhatsApp.

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Which session(s) are you registering for? *

Select the session you wish to register for.

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Number of Lovely Learners you’re registering *

Please enter the number of Lovely Learners you are registering.

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How did you hear about Ms. Love’s Reading Rooms?

Please specify how you found out about the Reading Rooms.

Do your Lovely Learner(s) have any learning preferences or accessibility needs you’d like us to know about?

Please share any specific needs or preferences.

Are there any cultural or sensory considerations to help ensure your Lovely Learner’s comfort?

Please specify any considerations for comfort.

What helps your Lovely Learner(s) feel most comfortable when learning or sharing?

Please share tips for comfort and engagement.

Emergency Contact Name & Number *

Please provide the name and phone number of the emergency contact.

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Relationship to Lovely Learner(s) *

Please specify your relationship to the Lovely Learner(s).

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Photo/Video Permission *

Check one option below:

I permit my Lovely Learner’s photo/video to be used for program highlights, marketing, or social media.

I do not give permission

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Will your Lovely Learner be joining with support? *

Please confirm whether support will be present while joining.

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Do you consent to your Lovely Learner’s participation on a virtual platform? *

Please confirm your consent for virtual participation.

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What inspired you to register your Lovely Learner for this experience?

Please share your thoughts and inspiration.

Would you like to receive updates about future interactive workshops, Reading Rooms, or Ms. Love Merch?

Please select one option below:

Consent Acknowledgement *

By submitting this form, I acknowledge that I am the Caring Adult of the registered Lovely Learner(s) and consent to their participation in Ms. Love’s Interactive Reading Rooms.

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Payment *

C$10.00

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