Student Sign Up Form

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Achieve Student Sign Up Form

* Indicates required field

Student Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Student's Current Grade (if summer grade student will enter in Fall) *

Date of Birth *

Parent/Guardian Name *

First

Last

Relationship *

Parent/Guardian Phone Number *

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

Is it ok to text this number? *

Yes No

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

Individual Tutoring Private Home School Program Music Lessons Academic Readiness Camp Virtual Learning In Person Learning

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

Reading Writing Math Science Social Studies Piano Voice Guitar ESL Technology Other

My child is involved in a 504 or Special Education Program. *

Please add additional Information Here that you would like us to know about your child. *

By typing my name below, I 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. *

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Home
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Tutoring
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About
Contact