2023-2024 Class Registration

$30.00

Registration Short Description

Category: Classes

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Billing details

Child's Name *

Date of Birth *

Current Grade *

Current Age *

Name of School *

First name *

Last name *

Country / Region *United States (US)

Street address *

Apartment, suite, unit, etc. (optional) (optional)

Town / City *

State *

ZIP *

Phone *

Email address *

Desired Classes *

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone *

Medical Allergies *

Medical Medications *

Medical Other Information (optional)

Additional information

I, the parent or guardian of the participant named above, agree to the waiver form below and allow Starstruck to keep an electronic signature for this on file. *

Order notes (optional)

Your order

Product Quantity	Total
Cart Subtotal	$0.00
Order Total	$0.00

Credit Card

Pay with your credit card.

Card number *
Expiry (MM/YY) *
Card code *

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