Enrollment Application Thank you so much for considering Achievement Center of Texas for your child or ward. We offer Day Care for children between three and 12 and Day Habilitation for young adults and adults 13 years or older. At this time, we cannot accept students into our program that are Level of Need (LON) 9 or have dual diagnoses with a mental illness (such as bipolar disorder, schizophrenia, etc.). After you fill out this form, pay the $35 application fee and click "submit," someone will email you our complete, printable application for you to complete and turn in. Your Name*Please submit your name as the parent or ward of the prospective student. First Last Prospective Student Name*Please submit the name of your child or ward. First Last Cell Phone*Please provide your cell phone number so we can contact you. Is it okay to text your cell phone?*YesNoEmail*Please provide the email address for the contact person. We will use this email address to communicate with you about your registration. Please check the box below if we can use this email address for other projects. Future Email Use Consent*We would like to send occasional emails about volunteer and other activities. We do not share, sell or lease your information. You will always be given the option to opt out of future emails. If you're already on our list nothing will change. Yes No Desired Program*Please select the program you would like to enter your child or ward in.Day Care (children 3-12)Day Habilitation (13+)Application Fee*Please enter "1" to indicate that you have completed this application for one prospective student. If you have another child or ward you would like to complete an application for, please start the process over after clicking "submit." Price: $35.00 Quantity: Total $0.00 This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.