Registration

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	Academic School District:*
	Physical Limitations:
	Allergies (If none, enter N/A):*
	Medications (Leave blank if NONE):
	Date of Most Recent Physical:*
	Previous Ballet Training?:*
	Previous Ballet Training cont.:

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Academic School District:*
	Physical Limitations:
	Allergies (If none, enter N/A):*
	Medications (Leave blank if NONE):
	Date of Most Recent Physical:*
	Previous Ballet Training?:*
	Previous Ballet Training cont.:

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Academic School District:*
	Physical Limitations:
	Allergies (If none, enter N/A):*
	Medications (Leave blank if NONE):
	Date of Most Recent Physical:*
	Previous Ballet Training?:*
	Previous Ballet Training cont.:

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Academic School District:*
	Physical Limitations:
	Allergies (If none, enter N/A):*
	Medications (Leave blank if NONE):
	Date of Most Recent Physical:*
	Previous Ballet Training?:*
	Previous Ballet Training cont.:

	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)

	Student Email:
	Academic School District:*
	Physical Limitations:
	Allergies (If none, enter N/A):*
	Medications (Leave blank if NONE):
	Date of Most Recent Physical:*
	Previous Ballet Training?:*
	Previous Ballet Training cont.:

I understand applicants with previous training experience are required to submit three photos to documents@cpyb.org to complete their application materials.

I understand upon submission of an application and the required photos for a student with previous experience, the CPYB Artistic Director will approve or disapprove the application. All applicants will be notified of their status.

I understand upon submission of this form, CPYB will charge an $80 application fee. Upon acceptance into the August course, the family will authorize the date the applicable tuition payment is charged against the family payment information within this application. If the authorization is submitted by July 15, tuition is $275 per week. If the authorization is submitted after July 15 and space is available in the program, tuition is $325 per week. Applicants may elect to take the full 2-week August Course or Week 1 only. Students may not elect to take Week 2 only.

I understand upon submission of this form, CPYB will charge a $35 application fee and the applicable tuition payment against the family payment information within this application as all beginners are accepted. If the application is submitted by July 15, tuition is $125 per week. If the application is submitted after July 15 and space is available in the program, tuition is $175 per week. Applicants may elect to take the full 2-week August Course or Week 1 only. Students may not elect to take Week 2 only.

Credit card authorizations returned unpaid for any reason incur a $35 declined transaction fee.

I have read and understand the Refund Policy as outlined in the Student Handbook available on the CPYB website. I understand that there will be no exceptions to these refund policies.

I acknowledge there are no scholarship programs to assist families financially during the August Course nor provision of residential housing.

My electronically typewritten signature below shall be legally binding and serve in the same capacity as my original penned signature.