SSRegistration20

Starstruck Registration 2020 - Moana Jr.

* Indicates required field

Participant Name (additional names can be entered below) *

First

Last

Email *

Parent Name *

First

Last

Phone Number *

Choose One *

One Child/Teen ($175) More than One (at $150/each additional sibling)

Names of any additional siblings (if applicable) *

Payment Options *

Payment Amount *

$175.00 (one participant) Other Amount (multiple family members - enter amount below)

Participant's Age (ages 6-High School Senior) *

Other Amount ($175 first participant, plus each additional participant at $150 each) *

Additional Participant's Age(s) - if applicable *

Please list any health/allergy information that we should be aware of - if none, please indicate as much *

Name as it appears on credit card (if paying online) *

First

Last

Credit Card Number *

Exp. Date *

Security Code *

Billing Zip Code *