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PACE ACADEMY
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Pace Academy Registration Interest Form
Student: First Name
Student: Last Name
Grade
Birth City, State & Country
Date of Birth
Address
Mailing Address (If Applies)
Student: Phone Number
Student: Email
Gender
Race
Has the student received special education services?
Disability Classification:
Last School Attended
Grade
Parent #1: First Name
Parent #1: Phone Number
Parent #2: First Name
Parent #2: Phone Number
Parent #1: Last Name
Parent #1: Email
Parent #2: Last Name
Parent #2: Email
Parent Signature
Date
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