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Achieve Student Information Form
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Indicates required field
Student Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Student's Current Grade
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Is your child enrolled in any special programs at school?
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Please include information for all parents/guardians that may be dropping off or picking up your child.
Parent/Guardian Name 1
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First
Last
Relationship
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Parent/Guardian Phone Number 1
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Parent/Guardian Email 1 (Please provide an email you check regularly)
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Is it ok to text this number?
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Yes
No
Parent/Guardian Name 2
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First
Last
Relationship
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Parent/Guardian Phone Number 2
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Parent/Guardian Email 2 (Please provide an email you check regularly)
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Please add additional Parent/Guardian Information Here
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Is it ok to text this number?
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Yes
No
Services (Please choose all that you are interested in or apply.)
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Ages 5-7 Home school Program
Ages 8-14 Home school Program
High School Home school Program
Music Lessons
CSI Math Camp
STAAR Bootcamp
Individual Tutoring
Homework Help
Student Success Coaching
Group Tutoring
Skills Saturday Group Classes
Adult ESL Class
Child ESL Class
Family ESL Class
Achieve Typing! Class
Technology Readiness Class
K-8 Readiness Camp
Virtual Tutoring
Subject Matter (Please choose all that you are interested in or apply.)
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Reading
Writing
Math
Science
Social Studies
Piano
Guitar
Voice
Recorder
Flute
General Music
Amateur Radio
ESL
Technology
Other
Child's Learning Style (Please check all that apply.)
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Visual (learns best by seeing material)
Auditory (learns best by hearing the material)
Kinesthetic/Tactile (learns best by doing - hands-on)
Is there anything else you think we should know about your child? (Please note that you will also fill out a health form, photo release form, and teacher contact form.)
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By typing my name below, I acknowledge that I have entered all information necessary to help Achieve Learning Center provide the best learning experience for my child.
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Home
Home School
Tutoring
Music Lessons
Camps
Parents
About
Contact
Calendar
Forms
Store
Employment