K-12 Coders Online Registration

Registration

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Welcome to K-12 Coders! We are thrilled you're here. Please complete the following registration form to reserve a seat for your child (ren). Make sure you log in to your parent portal for course information. Don't forget to select a 4-digit pick-up code that will be used whenever someone picks up your child(ren). There is a one-time $75 registration fee per family. Complete the required fields where * denoted. DHS Vouchers Accepted at participating locations!

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Select a 4-Digit Pick-up Code*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search 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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search 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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search 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* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size*

School

Grade Level

Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Immunization Notes

Please click on the Search 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

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*

Jackrabbit Technologies' class management platform & registration portal is trusted by 1000s of
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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)

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)