Jubilate Homeschool Academy Online Registration

Registration

Already a customer? Click here to login.

Welcome to Jubilate Homeschool Academy ! Please complete the following registration form. If you have any questions about your classes, please reach out to the teacher directly.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier*

Authorized Pick Up List*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

School Name:*

Voucher Pay? Y or N*

If No, cash or check?*

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

School Name:*

Voucher Pay? Y or N*

If No, cash or check?*

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

School Name:*

Voucher Pay? Y or N*

If No, cash or check?*

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

School Name:*

Voucher Pay? Y or N*

If No, cash or check?*

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Grade Level*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

School Name:*

Voucher Pay? Y or N*

If No, cash or check?*

Please click on the Select Class button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Required Policies

(Show-Hide Details)