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Winter STEAM Student Sign Up Form
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Indicates required field
Student Name
*
First
Last
Address
*
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
*
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
Preferred Dates (please check all that you are interested in or apply)
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Monday, December 22
Tuesday, December 23
Monday, December 29
Tuesday, December 30
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)
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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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/STAAR Test Prep
Special Education Advocacy
Special Education Consulting (for schools or organizations)
Virtual Private School Program
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 and that payment must be received in full prior to service dates.
*
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Achieve Advocacy & Consulting
Tutoring
Camps
About
Contact
