PACE Class Enrollment Form
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Email *
Class Code
Payment Date
MM
/
DD
/
YYYY
Name of Student *
Date of Birth *
MM
/
DD
/
YYYY
Grade in School for Fall 2020
Which School Does Student Attend
Student Address *
Student Phone (if applicable)
Student Email (if applicable)
Parent/Guardian Name *
Is Address same as Student? *
Parent/Guardian Phone Number *
Parent/Guardian Email *
Emergency Contact *
Emergency Number *
Any Allergies/ or Special Needs *
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