PARTICIPANT INTAKE FORM

Confidential
Ethnicity
 
Student lives with
Check appropriate information

If Child lives with grandparent or guardian, please complete this information

What, as parents or guardian, will be your commitment to the Performing Stars program? What may we reasonably expect from you in terms of support and service? (Please check one or more of the following)
 
Current employment status
 
Household Information
Please give information for all people living in your home INCLUDING yourself.
The cost for your child to participate in Performing Stars of Marin
At present, monthly dues are $5.00 per month per child. This works out to be $1.00 per week for your child to participate in a quality arts program. It is important to pay these monthly dues, because they will provide the necessary enrichment items that will be used in each program. Dues have to be paid by the first of each month. If they are not paid, your child may not be able to participate.

Thank you for your time and for providing us with your information.
We really appreciate it.

 

Felecia Gaston
Founder & Executive Director                                                                                                       (11.24.14)


Powered byFormsiteReport abuse