Summer Camp Student Sign Up Form
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Student's Date of Birth
Student's current school
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)
Number Sense Camp (This is a 2 week camp.)
Reading Skills Camp
Public Speaking Camp
CSI Math Camp
All Inclusive Academic Camp
All Inclusive Academic Plus Camp (includes individual tutoring)
Is it ok to text this number?
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)
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
After School Enrichment
Fine Arts (Music, Art, Theater)
SRP (Reading Specialty Program)
Youth Group or Church Programs
Dual Enrollment Classes
Other (please add information in the notes section below)
Youth Extra Large
Adult Extra Large
I am interested in learning more about other services Achieve offers. (Please check all that apply.)
Occupational Therapy Assessment
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.
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