TiPP Reservation Form
TEACHERS IN PRIVATE PRACTICE / 2018-19
ACADEMIC SUPPORT & ENRICHMENT Monday through Thursday
August 20, 2018 through May 23, 2019
with Mrs. Prell and Mr. Thomas

To request a spot for your child, please complete the form below. We will confirm your reservation(s) by e-mail and explain next steps.

Thank you!

NOTE: Please complete one form for each child.
Email address *
First Name *
Parent or Guardian
Your answer
Last Name *
Parent or Guardian
Your answer
Relationship to Child *
Phone number *
Where you can best be reached
Your answer
RESERVATION INFORMATION
1. Child's Name *
NOTE: Please complete one form for each child.
Your answer
Gender *
Academic Coach *
Choose all that apply.
Required
Grade Level in 2018-19 *
When can your child see Mrs. Prell and/ or Mr. Thomas?
Choose the potential day(s) you'd like to reserve. Check all possibilities. (We will confirm availability.)
When can your child see Mrs. Prell and/ or Mr. Thomas?
Choose the potential time(s) you'd like to reserve. Check all possibilities. (We will confirm availability.)
How did you hear about us?
If someone referred you, please let us know so we can properly thank them!
Your answer
Comments or Questions
Your answer
A copy of your responses will be emailed to the address you provided.
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