Please associate child's name with any allergies or medications. If none, please write NONE.

I further authorize a representative of PAIDEIA CLASSICAL EDUCATION, a service of
Parent And Child Educational Services (PACES) to take my child for any emergency
medical treatment needed during school hours and I will be responsible for the charges

Please Note: In order to complete this form, we will need a copy of your current insurance card(s) to keep on record. Please scan the front and back and upload using the link above. If you don’t have access to a scanner, please bring your card(s) to the school and we will make a copy for you.

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