2021-2022 Request for Enrollment

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Email *

Student Legal Name: (Last, First, Middle) *

Gender: *

Male

Female

Parent/Guardian Name(s): *

Student Date of Birth: *

YYYY

Grade (2021-2022): *

Physical Address: *

Mailing Address: (if different)

Home/Cell Phone: *

Siblings currently (attending or applying at PAC?) *

Attending

Applying

Name and Grade of siblings

In the student's home, is there a computer? *

Yes

Is there anything else you would like us to know about your child?

How did you hear about PAC? *

Facebook

Instagram

Niche

Google Search

In Style Magazine

Growing Up Roseville

Sacramento Parent

Referral from Friend

Other:

I attest that the above statements are true to the best of my knowledge. I understand that falsification of any of the information on this enrollment application may result in the student being disenrolled from the school. *

Yes

Required

Parent Signature *

Please Note: PAC complies with all applicable state and federal laws in serving students with disabilities including but not limited to Section 504 of the Americans with disabilities Act and the Individuals with Disabilities in Education Act. The Charter School intends to function as a “public school of the local education agency (LEA) that granted the charter” for purposes of providing special education and related services pursuant to Education Code Section 47641 (b).

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