Welcome Achievers 2019-2020
Parents/ Guardians, please fill out this form before 31st August 2019. $20 registration fees will be collected on the Achievers Kick Off Day 2019-20. (7th September).
Forms of accepted payments-  Credit Card, Checks or Cash.
If registering multiple students (siblings) please submit a different form for each student.
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Personal Information
This information will only be shared for the purpose of communication from Achievers.
Is the participant a returning Achiever? *
Has he/she currently or have been a part of any College Prep program previous ? *
Parent/Guardian's  First Name *
Parent/Guardian's  Last Name *
Parent/Guardian's  Home Address *
Parent/Guardian's  Phone Number *
Parent/Guardian's  Email *
Parent/Guardian's  Date Of Birth *
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Parent/Guardian's  Gender *
Student Information
Student's First Name *
Student's Last Name *
Student's Phone Number *
Student's Email *
Student's Date Of Birth *
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Student's Gender *
Race *
School Attending *
Grade *
Current GPA (unweighted) *
Family Income *
Is your son/daughter eligible to receive reduced lunch? *
Is your son/daughter a first generation student? (A first-generation college student is defined as a student whose parent(s)/legal guardian(s) have not completed a bachelor’s degree at a four-year college or university) *
Please describe any food allergies *
Waiver, Photography Release, & Required Signature
In having a YMCA of Greater Cincinnati and/or participating in YMCA programs, I agree to cooperate with others in supporting the YMCA mission, goals, and objectives and to abide by the policies and procedures set forth by the YMCA of Greater Cincinnati Board of Directors. I do hereby agree to hold free from any and all liability the YMCA of Greater Cincinnati, and its officers, employees, and members, and do hereby myself, my heirs, executors, and administrators, waive, release, and forever discharge any and all claims for damages which I may incur, or which hereafter accrue to me, arising out of or connected with my participation in any of the activities of the YMCA. I understand that membership dues are non-refundable and membership privileges may not be transferred from one individual to another. I give my permission and consent to the use of any photographs,videotapes, or other media record of my participation at the YMCA of Greater Cincinnati for any lawful purpose, without compensation to me or on my behalf.If I choose not to be photographed, videotaped, or in other recorded media, it is my responsibility to inform the photographer and/or remove myself from the picture. *
By Typing your name here you give consent.
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