đź“‹Online Learning with Mrs. Prell - Registration
Mrs. Prell's Educational Services, LLC

NEW FAMILIES: Complete this REGISTRATION FORM to register your child(ren) for Online with Mrs. Prell. (If you've registered your child in the last 10 weeks, you do not need to complete this form again.)

PRIMARY CONTACT / RESPONSIBLE PARTY: Please complete the information below to register your child(ren) for private (1:1) during the school year or summer.
Email *
First Name: *
Parent or Guardian
Last Name: *
Parent or Guardian
Relationship to Child(ren) *
Address: *
Number and Street
City: *
Zip Code: *
Mobile Phone: *
Where you can best be reached
EMERGENCY CONTACT
Emergency Contact's Name *
Emergency Contact's Relationship to Child(ren) *
Emergency Contact's Phone Number *
Family Doctor's Name *
Family Doctor's Phone Number and City *
REGISTRATION INFORMATION
1. Child's Name *
Gender *
Birthday *
MM
/
DD
/
YYYY
Grade Level *
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