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Studio Address: 11650 W 85th St. Overland Park KS 66214


STARSTRUCK PERFORMING ARTS CENTER
ENROLLMENT FORM


NAME:

AGE:

STREET ADDRESS: 

CITY:      STATE:      ZIP: 

PHONE NUMBER:  ( ) - -

BIRTHDATE:      

PARENTS NAMES:     Mother -   Father -

EMERGENCY CONTACT:  

MEDICAL CONDITIONS:  

SCHOOL: 

YEARS OF EXPERIENCE: 

HOW DID YOU HEAR ABOUT US? 

CLASS ENROLLMENT (enter class information below)

1.
2.
3.
4.
5.

TOTAL HOURS:  

MONTHLY TUITION SUBTOTAL:                                                  

Tuition for 2008

Hours per week

Tuition Monthly

1 hour        

$45.00

1.5 hours

$63.00

2 hours  

$85.00

2.5 hours     

$100.00

3 hours       

$115.00

3.5 hours     

$130.00

4 hours  

$140.00

4.5 hours     

$160.00

5 hours                

$180.00

Unlimited             

$190.00

 

                                      
                                                                                                                  
 NEW STUDENT FEE:                                                                        
TOTAL DUE:                                                                                          

THE UNDERSIGNED, INCONSIDERATION OF PARTICIPATION IN THIS PROGRAM,




AGREES TO INDEMNIFY, HOLD HARMLESS, 



AND RELEASE STARSTRUCK P.A.C.




AND ITS INSTRUCTORS FROM ANY 



AND 



ALL LIABILITY WHICH 



MAY BE SUFFERED




BY THE ABOVE NAMED INDVIDUAL REGISTERED IN THIS PROGRAM ARISING OUT OF




OR IN ANY WAY CONNECTED WITH PARTICIPATION IN THIS PROGRAM.

SIGNATURE OF PARENT: _______________________________________________
DATE:                                      ________________