Registration

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This application is required for any students interested in staying at Chatham University for PBT School's Intensive Summer Program, Company Experience, or Youth Summer Intensive. This application will aid the School Team and Residential Advisors ahead of our summer programming. We are collecting dietary restrictions, any relevant medical notes, and some personal information to best match roommates. Students must be under 21 years of age to stay in the dormitory housing. If you are turning 18 years old during your stay, please let us know. Any questions can be sent to pbtschool@pittsburghballet.org.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)
	Student Email:
	School:	Grade Level:*
	Disabilities (Leave blank if 'none'):
	Allergies (Leave blank if 'none'):
	Medications (Leave blank if 'none'):
	Racial/Ethnic Background (Used for data purposes only. "N/A" if not sharing.):*
	Gender identity/expression:

Questions/Options:


If you are requesting a specific roommate, please list their name here.
Please list any habits to be taken into consideration when assigning roommates (i.e. early bedtime, sensitivity to smells, prefers no visitors in the room, likes, dislikes, etc.)
Would you prefer to have a single room? Please note that some students may be required to share a room due to the available space.*
Please list any dietary restrictions.
Please list any medical needs we should be aware of.
Please list any allergies, including type, severity, and associated treatments.
Please provide details of any medications you take. More details can be shared in the medical form, but all medications should be listed in case of an emergency.
Are you requesting an air conditioner? (This requires a doctor's note and payment of a related fee before move-in.)

Additional Information:

Handbook

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Payment

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Paperwork

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Enter your Full Name: