ACTivate Your Success
ACT Prep Workshop
Section 1: Student Information
Student's Name
First Name
Last Name
Student's Current Grade Level
7th
8th
9th
10th
11th
12th
Name of the School you attend.
Student's Email
example@example.com
Section 2: Parent Information
Parent/Guardian's Name
First Name
Last Name
Parent/Guardian's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian's Email
example@example.com
Section 3: ACT Preparation
Have you taken the ACT before?
Yes
No
Which ACT subject would you like more support with? Select all that apply.
English
Math
Reading
Science
Not Sure/General ACT Preparation
What is your primary goal for attending?
Prepare to take the ACT for the first time.
Improve my ACT score
Learn test-taking strategies
Build confidence
Strengthen academic skills
Other
Section 4: Event Planning
Does the student have any food allergies or dietary restrictions?
Does the student need any accommodations to participate?
Do you give permission for photographs and videos of your child to be taken and used for event publicity?
Yes, I give permission.
No, I do not give permission.
Section 5: Student Drop-Off and Pick-Up Authorization
Who is authorized to pick up your child?Please provide the full name and phone number of the person(s) authorized to pick up your child.
Do you acknowledge that your child will be dropped off for the ACTivate Your Success ACT Prep Workshop and picked up promptly at 11:30 a.m.?
Yes, I acknowledge and agree.
No
Will your child be permitted to leave the workshop independently?
Yes, I authorize my child to leave independently at the conclusion of the workshop.
No, my child must be released to an authorized adult.
Section 5: Parent/Guardian Acknowledgment
Parent/Guardian Acknowledgment:
I understand that my child will participate in the ACTivate Your Success ACT Prep Workshop on Saturday, November 14, 2026, from 8:30 a.m. to 11:30 a.m. I agree to arrange for my child's timely pickup and understand that my child will only be released according to the authorization provided on this registration form.
Parent/Guardian Signature
Submit
Should be Empty: