Sign up for Napoleon's Adventure Club!

YES! Enroll my child into Napoleon's Adventure Club

The answers you provide will help us begin to understand if this local bookclub benefits your family over the next year. Your information will be kept private. You may also enroll by calling 2-1-1.

Is your child enrolled in a child care program? Yes No

If yes, what type?

Other:

If no, where does your child stay during the day?

Other:

How often do you read with your child?

How often do you do activities related to reading with your child, such as talking often and listening carefully, expanding on what your child says, singing songs and reciting rhymes, or asking questions?

How often do you take your child to places such as parks, museums, libraries, the zoo, etc?

Optional Information About You:

Marital status:

Household Income:

Race/Ethnic Classification:

Other:

Name of Parent:

You may enroll any children in your home who have not yet entered kindergarten.

Name of child 1: Birthdate:

Name of child 2: Birthdate:

Name of child 3: Birthdate:

Address:

City: State: (IN) Zipcode:

Phone:

Email:

For more information, call 2-1-1 or 812-422-4100. Follow Napoleon Peacock on Facebook or Twitter!

Napoleon is here to help your child learn to love reading! There will never be any cost or attempt to sell you anything. We will mail six local children's books and activity guides, occasional Napoleon-related information and a final survey.