Student Information Form

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Achieve Student Information Form

* Indicates required field

Student Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Student's Current Grade *

Is your child enrolled in any special programs at school? *

Please include information for all parents/guardians that may be dropping off or picking up your child.

Parent/Guardian Name 1 *

First

Last

Relationship *

Parent/Guardian Phone Number 1 *

Parent/Guardian Email 1 (Please provide an email you check regularly) *

Is it ok to text this number? *

Yes No

Parent/Guardian Name 2 *

First

Last

Relationship *

Parent/Guardian Phone Number 2 *

Parent/Guardian Email 2 (Please provide an email you check regularly) *

Please add additional Parent/Guardian Information Here *

Is it ok to text this number? *

Yes No

Services (Please choose all that you are interested in or apply.) *

Individual Group Classes Home School Tutoring Music Lessons CSI Math Camp

Subject Matter (Please choose all that you are interested in or apply.) *

Reading Writing Math Science Social Studies Piano Guitar Voice Recorder General Music Amateur Radio

Child's Learning Style (Please check all that apply.) *

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.) *

By typing my name below, I acknowledge that I have read and accept the policies and fees set forth by Achieve. Please be sure to read our policies and fees you are agreeing to. *

Submit

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