Sign Up Form Community Assistance Program

Filling out the form below does not guarantee you will receive the dates and times you select. All participants in the Community Assistance Program must fill out Achieve Learning Center's required paperwork before their children will be admitted into the building including the COVID-19 waiver. Failure to do so will result in cancellation of your slots.

COVID-19 Community Assistance Program Student Sign Up Form

* Indicates required field

Student Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Student's Current Grade (if summer grade student will enter in Fall) *

Parent/Guardian Name *

First

Last

Relationship *

Parent/Guardian Phone Number *

Parent/Guardian Email (Please provide an email you check regularly) *

Is it ok to text this number? *

Yes No

Please add additional Information Here if necessary. *

By typing my name below, I acknowledge that I am beginning the sign up process for services at Achieve. I agree to be contacted by Achieve to continue the registration process before sessions begin. *

Submit