#1 ARTS Student Enrollment Form

Welcome to the ARTS Program This program, created by Gainesville Youth Academy and PEAK Literacy, gives your child the chance to grow in confidence and skill through fun, creative learning activities.

Every day, students will get one-to-one reading lessons using a proven program that helps children grow stronger and faster in reading. They will also have time to explore their creative side through music, movement, art, and theatre, giving them a chance to express themselves and work together with others.
There are four forms you will need to fill out to complete your child's enrollment. The estimated time for completion is approximately 20 minutes.

Privacy and Data Protection: Your privacy is of utmost importance to us. Rest assured that your personal data and information will never be shared. The data we collect will be used in the aggregate for reporting and applying to granting agencies. Personally-identifying information is never utilized in these activities.
Student Name

First NameLast Name
Gender
Student's Race/Ethnicity
Student DOB: This information helps us determine appropriate reading levels.

MonthDayYear
Date
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The student is in ___grade for the 2025/26 school year
My child attends ________ school for the 2025/26 school year.
Name of School
The student's current/most recent grade in Reading/ELA is:
Has the student been diagnosed with a learning disability related to reading
What is the primary language spoken in the home?
Is English your child's first language?
Parent/Guardian #1 Name

First NameLast Name
Parent/Guardian #1 Email
example@example.com
Parent/Guardian #1 Cell Phone Number
.Format: +1 (000) 000-0000.
I agree to receive meeting reminders via SMS from PEAK Literacy as well as updates in regards to my child's lessons (no more than 2/week). Opt out by replying STOP to cancel
What is the highest level of education Parent #1 has completed?
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Cell Phone Number
.Format: +1 (000) 000-0000.
I agree to receive meeting reminders via SMS from PEAK Literacy as well as updates in regards to my child's lessons (no more than 2/week). Opt out by replying STOP to cancel
What is the highest level of education Parent #2 has completed?
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How many people are in your family/household?
Household Yearly Income
Does the student qualify for free/reduced lunch?
Who, if anyone, may we thank for referring you?
After submitting, you will be directed to form 2/4
Should be Empty:

Welcome to the ARTS Program This program, created by Gainesville Youth Academy and PEAK Literacy, gives your child the chance to grow in confidence and skill through fun, creative learning activities.

There are four forms you will need to fill out to complete your child's enrollment. The estimated time for completion is approximately 20 minutes.

After submitting, you will be directed to form 2/4