Jim Jam Music Studios Online Registration

Registration

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Welcome to Jim Jam Music! We can't wait to see you soon. Please complete the following registration form.

* 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*

Postal Code*

Additional Info

Emergency Contact Info*

Alternative caregiver

Contact #1

Parent #1 First Name*

Last Name *

Relationship to Child*

How Can We Contact You?

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

Parent #2 First Name

Last Name

Relationship to Child

How can we contact you?

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School Grade (if applicable)

Disabilities/Additional Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Immunization Notes

Creative Kids Voucher number

Name on the voucher

Please click on the Search button below, then choose the class you wish to enrol in.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School Grade (if applicable)

Disabilities/Additional Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Immunization Notes

Creative Kids Voucher number

Name on the voucher

Please click on the Search button below, then choose the class you wish to enrol in.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School Grade (if applicable)

Disabilities/Additional Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Immunization Notes

Creative Kids Voucher number

Name on the voucher

Please click on the Search button below, then choose the class you wish to enrol in.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School Grade (if applicable)

Disabilities/Additional Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Immunization Notes

Creative Kids Voucher number

Name on the voucher

Please click on the Search button below, then choose the class you wish to enrol in.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School Grade (if applicable)

Disabilities/Additional Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Immunization Notes

Creative Kids Voucher number

Name on the voucher

Please click on the Search button below, then choose the class you wish to enrol in.

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out CREDIT CARD Payment Method

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Postal Code*

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank State Branch (BSB) Number (6-digit number)

Account Number

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

eCheck/Bank Draft

Required Policies

(Show-Hide Details)