Free Consultation & Free Trial Class 2023 Application
Address: Unit 1215, 12/F, One Island South, 2 Heung Yip Road, Wong Chuk Hang
Contact us at 23688848 or admin@pacecenter.com.hk
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Email *
Contact Number *
Parent's Name *
Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
School  *
If your child is not attending school, please fill in N/A.
Grade  *
If your child is not attending school, please fill in N/A.
Does your child go to am/pm school? *
If your child is not attending school, please fill in N/A.
Languages *
Required
Any Diagnosis *
Required
Main Concerns  *
Required
Services you are interested in (Check all that apply) *
Required
Availability for Free Trial Class - Child Only (Check all that apply) 
Each trial class lasts for 1 hour. Please let us know your child's availability for the next 2 weeks and we will arrange a trial class for him/her. Thank you!
AM (9am-1pm)
PM (1pm-6pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Would you like to arrange a consultation meeting right after the trial class? *
Observation sharing will be given during the meeting.You may arrange both trial class and consultation meeting on the same day, or separate them into two different day if you prefer. 
Availability for Free Consultation - Parent Only (Check all that apply) 
Each consultation lasts for 30-45 mins. Please let us know your availability for the next 2 weeks and we will arrange one for you as soon as possible. Thank you!
AM (9am-1pm)
PM (1pm-6pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Consultation Format *
Required
Special Notes
Please let us know any special information that you would like to share with us. 
Thank you, we will contact you shortly! 
A copy of your responses will be emailed to the address you provided.
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