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Summer Camp Student Sign Up 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 Age
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Student's Date of Birth
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Student's current school
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Grade Level Entering in Fall 2025
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Parent/Guardian Name
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First
Last
Relationship
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Parent/Guardian Phone Number
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Parent/Guardian Email (Please provide an email you check regularly)
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Is it ok to text this number?
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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!)
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Preferred Dates (please check all that you are interested in or apply)
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June 2nd-6th Summer Fun
June 9th-13th STEAM
June 16th-20th Gamer IRL (In Real Life)
June 23rd - 27th CSI (Crime Scene Investigation)
June 30th-July 3rd USA Week
July 7th-11th STEAM
July 14th-18th Summer Fun
Length of Week
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Full Week (Monday-Friday)
Monday/Wednesday
Tuesday/Thursday
Monday
Tuesday
Wednesday
Thursday
Friday
I need a different schedule each week..
Please note the schedule that you need for your family.
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Length of day
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Full Days (8:00 a.m. - 5:00 p.m.)
Half Day AM (8:00 a.m. - 12:30 p.m.)
Half Day PM (12:30 p.m. - 5:00 p.m.)
Partial Day (you choose the hours)
I need a different schedule each day/week
I need extended day hours
Please note the schedule that you need for your family
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My child is currently in the following programs
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Sports
After School Enrichment
Fine Arts (Music, Art, Theater)
504
IEP
BIP
Reading Intervention
Math Intervention
OT
Counseling
Youth Group or Church Programs
Tutoring
Dual Language, ESL or EB
Other (please add information in the notes section below)
T-Shirt Size (check all sizes that apply)
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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.)
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Tutoring
Homeschool Coaching (structure or learning new curriculum)
Homeschool Curriculum Selection
Student Success Coach
Academic Assessment
Parenting Groups
SAT/ACT/TSI/Military Test Prep
Teacher Monitored Digital Learning Programs
Private School Program (coming in 2026)
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.
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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 Learning Center. I agree to be contacted by Achieve Learning Center to continue the registration process before sessions begin. I understand that filling out this form does not guarantee my child's admission into Achieve Learning Center programs.
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