Registration Form

Starburst Dance Registration Form
Please fill out one form per child. After submitting this, watch your mail for further instructions. Thank you for choosing Starburst Dance.

Tuition Rates:

Length of class	Classes	Tuition Rate
30 minutes	Tots or Boys	$35/month
45 minutes	Preschool or Kindergarten/1st grade	$42/month
60 minutes	Level 1 or Level 2	$48/month
90 minutes	Level1 or Level 2 + Jazz	$55/month

Starburst offers the following discounts. Please note that only ONE discount per family will apply.

2 dancers per family = $5.00 off total monthly tuition

3 dancers per family = $10.00 off total monthly tuition

4+ dancers per family = $15.00 off total monthly tuition

OR Pay for ½ year in advance = 5% off total year tuition

Pay for full year in advance = 10% off total year tuition

Be sure to send your registration fee ($10 for a single student or $15 for family) and September's tuition at least 5 days before the first class to secure your spot. Send check made payable to Starburst Dance to 428 County Rd SS, Roberts, WI 54023.

Student Full Name

First class choice

Second class choice

Student's age

Grade entering in fall

Parent Last Name *

Parent First name

Street

City

State/Province

ZIP/Postal Code

Primary contact phone

Alternate phone

Emergency phone number

Emergency contact name

E-mail address

Spouse/Partner Full Name

Questions or comments

Dance for children ages 2 -11