Student Enrollment Application

THE ACHIEVERS
TRAINING ACADEMY

Student Enrollment Application

Enrichment • Leadership • Career Readiness • Personal Growth

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Application Submitted Successfully

Thank you for submitting your application to The Achievers Training Academy. Your information has been received and our team will review it shortly.

Unable to Submit Application

Please review the information below and try again.

Student Information

Student Full Name *

Date of Birth *

Age *

Grade Level *

School Name *

Home Address *

City *

State *

ZIP Code *

Student Phone Number (Optional)

Parent / Guardian Information

Parent / Guardian Name *

Relationship to Student *

Phone Number *

Email Address *

Preferred Contact Method *

Phone Email Text Message

Emergency Contact

Emergency Contact Name *

Relationship to Student *

Phone Number *

Health & Safety Information

Does the student have any allergies? *

No Yes

If yes, please list all known allergies:

Does the student have any dietary restrictions? *

No Yes

If yes, please explain:

Is there any additional health, safety, learning, behavioral, or accommodation information Academy staff should be aware of?

Program Participation

How did you hear about The Achievers Training Academy? *

School Community Event Mission Achieve Social Media Friend or Family Other

If other, please specify:

Has your student previously participated in a Mission Achieve program? *

Yes No

If yes, please list the program or activity:

Transportation

How will the student get to and from the program? *

Parent / Guardian Drop-Off & Pick-Up Authorized Adult Drop-Off & Pick-Up School Transportation Public Transportation Walking / Biking Other

If other, please specify:

If someone other than the parent/guardian will pick up the student, please list the authorized person(s):

Authorized Person #1 — Name

Relationship

Authorized Person #2 — Name

Relationship

Photography & Media Consent

The Achievers Training Academy and Mission Achieve may photograph or record students during Academy workshops, activities, events, field trips, and other program-related activities.

Photos and videos may be used for program documentation, educational purposes, social media, websites, newsletters, promotional materials, community outreach, and grant reporting.

Please select one: *

Student Name *

Parent / Guardian Name *

Parent / Guardian Signature *

Date *

Parent / Guardian Authorization

I certify that the information provided in this application is accurate and complete to the best of my knowledge. I give permission for my child to participate in The Achievers Training Academy and understand that Academy activities may include educational workshops, interactive learning activities, group activities, guest speakers, community events, and other enrichment experiences.

I understand that my child is expected to follow Academy guidelines, respect staff, instructors, volunteers, and other participants, and participate appropriately in program activities.

Parent / Guardian Name *

Date *

Parent / Guardian Signature *

Student Commitment

I agree to participate in The Achievers Training Academy, respect others, follow Academy guidelines, and make a positive effort to learn and grow.

Student Signature *

Date *

THE ACHIEVERS
TRAINING ACADEMY

Student Enrollment Application

Application Submitted Successfully

Unable to Submit Application

Student Information

Parent / Guardian Information

Emergency Contact

Health & Safety Information

Program Participation

Transportation

Photography & Media Consent

Parent / Guardian Authorization

Student Commitment

Quick Links

Contact Info

Ready to Support Your Child’s Growth?

THE ACHIEVERS TRAINING ACADEMY

Student Enrollment Application

Application Submitted Successfully

Unable to Submit Application

Student Information

Parent / Guardian Information

Emergency Contact

Health & Safety Information

Program Participation

Transportation

Photography & Media Consent

Parent / Guardian Authorization

Student Commitment

Quick Links

Contact Info

Ready to Support Your Child’s Growth?

THE ACHIEVERS
TRAINING ACADEMY