Joobilo Academic Community Online Registration

Registration

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Welcome to Joobilo Academic Community! Please fill out the following registration form to complete your enrollment.

* 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

Health Insurance Carrier*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Joobilo Academic Community. Standard message and data rates apply. Reply STOP to opt out

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 # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Joobilo Academic Community. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Joobilo Academic Community. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email (If different than parents)

Charter School (If not with a Charter please state N/A)*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Charter School Name*

Teacher Facilitator's Name*

Your Teacher's Email*

Please click on the Search button below, then choose the class or class(es) you'd like to enroll in.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Joobilo Academic Community. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email (If different than parents)

Charter School (If not with a Charter please state N/A)*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Charter School Name*

Teacher Facilitator's Name*

Your Teacher's Email*

Please click on the Search button below, then choose the class or class(es) you'd like to enroll in.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Joobilo Academic Community. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email (If different than parents)

Charter School (If not with a Charter please state N/A)*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Charter School Name*

Teacher Facilitator's Name*

Your Teacher's Email*

Please click on the Search button below, then choose the class or class(es) you'd like to enroll in.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Joobilo Academic Community. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email (If different than parents)

Charter School (If not with a Charter please state N/A)*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Charter School Name*

Teacher Facilitator's Name*

Your Teacher's Email*

Please click on the Search button below, then choose the class or class(es) you'd like to enroll in.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Joobilo Academic Community. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email (If different than parents)

Charter School (If not with a Charter please state N/A)*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Charter School Name*

Teacher Facilitator's Name*

Your Teacher's Email*

Please click on the Search button below, then choose the class or class(es) you'd like to enroll in.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

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

Credit Card

Required Policies

(Show-Hide Details)