Home
Home School
Tutoring
Music Lessons
Camps
Parents
About
Contact
Calendar
Forms
Store
Employment
Summer Camp Student Sign Up Form
*
Indicates required field
Student Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Student's Age
*
Student's Date of Birth
*
Student's current school
*
Parent/Guardian Name
*
First
Last
Relationship
*
Parent/Guardian Phone Number
*
Parent/Guardian Email (Please provide an email you check regularly)
*
Camp Choices (please choose all that apply)
*
Kindergarten Readiness Camp (Entering Kinder in Fall 2022)
Beginning Reading Camp (Ages 5-7)
Writing Camp
Number Sense Camp (This is a 2 week camp.)
Reading Skills Camp
Typing Camp
Public Speaking Camp
STEAM Camp
Science Camp
CSI Math Camp
All Inclusive Academic Camp
All Inclusive Academic Plus Camp (includes individual tutoring)
Is it ok to text this number?
*
Yes
No
Please thank the wonderful person who referred me by giving them $25 off their camp fee! (Type their name below, so we can thank them!)
*
Preferred Dates (please check all that you are interested in or apply)
*
June 6-9
June 13-16
June 20-23
June 27-30
July 11-14
July 18-21
July 25-28
August 1-4
Days of Week and/or Time of Day (choose all that you are interested in or apply)
*
Half Day Morning 8:00 a.m. - 12:00 p.m.
Half Day Afternoon 12:00 p.m. - 4:00 p.m.
Full Day 8:00 a.m. - 4:00 p.m. (only available for students 8 and up)
Beginning Reading/Kindergarten Readiness Camp ONLY Monday/Wednesday 1:00-3:00 p.m.
Beginning Reading/Kindergarten Readiness Camp ONLY Tuesday/Thursday 1:00-3:00 p.m.
Beginning Reading/Kindergarten Readiness Camp ONLY Monday/Wednesday 2:00-4:00 p.m.
Beginning Reading/Kindergarten Readiness Camp ONLY Tuesday/Thursday 2:00-4:00 p.m.
Reading Skills Camp ONLY Monday/Wednesday
Reading Skills Camp ONLY Tuesday/Thursday
My child is currently in the following programs
*
Sports
After School Enrichment
Fine Arts (Music, Art, Theater)
504
IEP
SRP (Reading Specialty Program)
SCSS
OT
Counseling
Youth Group or Church Programs
Tutoring
AP Classes
Dual Enrollment Classes
Other (please add information in the notes section below)
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
I am interested in learning more about other services Achieve offers. (Please check all that apply.)
*
Individual Tutoring
Academic Assessment
Occupational Therapy Assessment
Parenting Classes
In-Person Private School Program
Virtual Private School Program
Please add additional Information Here that may be helpful for staff to know to help your child have the best camp experience possible.
*
By typing my name below, I acknowledge that I have completed this form fully and accurately. I also 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. I understand that filling out this form does not guarantee my child's admission into Achieve's programs.
*
Submit
Home
Home School
Tutoring
Music Lessons
Camps
Parents
About
Contact
Calendar
Forms
Store
Employment