The Girls' Connection Application | Lori Stephens, LLC

top of page

Powerful Education Solutions Lori Stephens Education Advocate

Home
The Girls' Connection
About
Book Now
Services
Testimonials
Contact
Resources
The Girls' Connection Application
The Girls' Connecton Printable App
More

Use tab to navigate through the menu items.

(941) 312-4777

Application for The Girls' Connection

Student First name*

Student Last name*

Email

Phone

Nickname

Address*

Birthday

Allergies

Please list any diagnosis and/or learning disabilities/challenges so we may better serve your student.

Student Strengths:

Please tell us any areas of need your student may have or any information you would like us to know:

Emergency Contact Information #1- Name: Phone: Relation:*

Emergency Contact Information #2- Name: Phone: Relation:

Parent/Guardian Name*

Address*

Phone*

Email*

Parent/Guardian Name

Address

Phone

Email

Single choice

$100 per month paid annualy

$105 per month paid quarterly

$110 per month paid monthly

Contact

Powerful Education Solutions, LLC

40 Sarasota Center Blvd #101

Sarasota, FL 34240

office@loristephensllc.com

Phone: (941) 312-4777

Subscribe

Subscribe to my e-mail list to stay informed on updates, events and resources!

Thank you for subscribing!

Copyright 2024. Website by C2 Creative Media.

bottom of page