📋Online Learning with Mrs. Prell

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📋Online Learning with Mrs. Prell - Registration

Mrs. Prell's Educational Services, LLC

NEW FAMILIES: Complete this REGISTRATION FORM to register your child 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.)

Complete one form per child.

PRIMARY CONTACT / RESPONSIBLE PARTY: Please complete the information below to register your child for private (1:1), collaborative pair (1:2), or collaborative group (1:3) lessons during the school year or summer.

Email *

First Name: *

Parent or Guardian

Last Name: *

Parent or Guardian

Relationship to Child(ren) *

Father

Mother

Guardian

Other:

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 *

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