Registration

Product Name
Choose Your Location*
Class Choices - Jackson Academy
Please select one
Number of Children Enrolling*
Child's Name*
Date of Birth*
Second Child's Name*
Second Child's Date of Birth*
Third Child's Name*
Third Child's Date of Birth*
Parent's Name*
Mobile Number*
Email*
Consent for Photos*
- Yes
- No
I grant permission for my child to be photographed for use in marketing materials such as brochures, posters, Ms. Kay’s Kids & Keys webpage and Facebook page.
Pay Monthly*
- One Child
- Two Children
- Three Children
Your card will be charged this amount monthly. The $25 registration fee is included.
Pay Monthly_Group Piano*
- One Child
- Two Children
- Three Children
Your card will be charged this amount monthly. Includes registration fee and book.
Total
$0.00
Credit Card
Card Details
Cardholder Name
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