PACE Academy 2017 Intent-to-Return Form
We have enjoyed having your child as a student for the 2016-17 school year. It is our hope that your student will return to us next year. Therefore, we are asking you to confirm your enrollment intentions by completing the survey below:

Disclaimer: We have a limited number of seats available for the fall of 2017. Non-submission of this form will release your student's seat to a student on the waiting list for next year. Please answer the Media Release and Emergency Contact Questions even if your student is Not returning.

List the first and last name of all students attending PACE Academy (ex. 1. John Appleseed 2. Adam Appleseed)
Your answer
What is your student's Current Grade?
Required
List Teacher's Last Name (please list for all student(s )in household attending PACE.
Your answer
What is your Home Phone Number?
Your answer
What is your e-mail address?
Your answer
Street Address
Your answer
City
Your answer
Zipcode
Your answer
Parent or Guardian's Name
Your answer
What is your relationship to the student?
Your answer
Will your student return to PACE for the 17-18 school year?
If your student will NOT return to PACE what is the name of the new school?
Your answer
Do you have a New student who will attend PACE in the fall of 2017?
What is the Name of the New Student attending in the Fall?
Your answer
Will this student be in Kindergarten?
If you are Not returning to PACE in the Fall would you like to tell us why? (all information is kept confidential)
Your answer
Describe your overall experience with PACE this school year
What has been your overall experience with Administration ?
What has been your overall experience with Instructional staff?
What has been your overall experience with Support staff (security, business office, etc..)?
What do you like most about PACE?
Your answer
What do you like Least about PACE?
Your answer
Would you recommend PACE to anyone else?
What suggestions would you provide to improve PACE?
Your answer
Would you like to be contacted regarding your responses today?
Emergency Contact Information Contact Name and Phone Number
Your answer
Emergency Contact Information Contact Name and Phone Number
Your answer
Do you give PACE permission to videotape, photograph or record your student for general education and information purposes without time restriction or compensation? (Your student's full name will not be published or recorded).
If emergency treatment is necessary, 911will be called immediately. Every attempt will be made to contact a parent or guardian. If you cannot be contacted please provide the name and phone number of the person you would like us to contact?
Your answer
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