ACADEMY OF ACHIEVERS

Academy of Achievers
Parent Sign In Form

REQUIRED CONTACT INFORMATION

Kindly fill out the ENTIRE form below, and click the SUBMIT button at the bottom of the screen to send us your Sign In information.This allows us to have current contact information for you about your child (if you have more than one child attending, you must fill this form out for EACH child). This information MUST be filled out within 24 hours of registering your child in our facility.

NOTE: If you are NOT including a No. 2. Parent/Guardian's info for a child's Contact please enter NONE in those boxes and we will only use the No. 1. Parent/Guardian's info for CONTACT.

Thank you.

Your Child's Full Legal Name:	*
Your Child's Date of Birth:	*
No. 1. Parent/Guardian's Full Legal Name:	*
Your Address (include street, city, state & zip code):*
Your E-mail:	*
Your Telephone Number (with area code):	*
No. 2. Parent/Guardian's Full Legal Name:	*
Address (include street, city, state & zip code):*
E-Mail:	*
Telephone Number (with area code):	*
You may INCLUDE any additional info you'd like for us to have (Examples: work phone #'s, family phone #'s, hours of work, work location, child's nickname, etc.)?:

(Fields marked with * are required)