Ready to Register Your Child for a Class? Fill out this form!Fill out one form per student; Please note this is a request. Your registration is not confirmed until you hear back from me. Parent or Legal Guardian * First Name Last Name Phone Number for Parent or Legal Guardian * (###) ### #### Email for Parent or Legal Guardian * Class information, updates, and the Learn With Jillian Newsletter (which includes activities, events, updates, discounts, and more) will be sent to this email. Student * First Name Last Name Student's Age * Student's Email Providing a student email address is optional. When provided, homework assignments are sent to both parent and student. Students are welcome to email me with questions about homework, etc. It is my policy to cc parents on any email I send to their student. I would like to register my child for... * The Shoes books (Thursdays at 1:30pm PST) Learning Through Little House [continuing] (Thursdays at 2:30pm PST) Special class, by request Please tell me a bit about your student... * In which state do you and your child live and in what time zone? * How did you find out about Learn With Jillian classes? * If you found me via a flyer, please let me know where that flyer was. Thank you! Discount See discounts offered at: LearnWithJillian.com/discounts Request a discount (referral, siblings, trade), or enter a discount code below. Thank you for pre-registering your student for a Learn With Jillian class! I will be in touch soon with confirmation, additional details, and invoice.
