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2019 5-Week Summer Ballet Program Application: BEGINNING STUDENT
NEW students should complete this form in it's entirety. One application per student only. Families with multiple students in the same household should follow the "Multi-Student Application Instructions" on CPYB.org
RETURNING students must login to their Family Portal using the red link above. Please contact CPYB at 717.245.1190 if you need assistance with your username and password. Again, one application per student only.
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Event: |
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Start Date/Time: |
End Date/Time:
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Fee per Student:
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Room:
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* - denotes required fields |
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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Questions/Options: |
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Additional Information: |
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PROGRAM ACCEPTANCE
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I understand all beginning ballet students are accepted into the program immediately upon application.
I've read the above and agree.
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APPLICATION AND TUITION PAYMENT
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I understand upon submission of this form, CPYB will charge a $35 application fee AND the $350 tuition payment against the family payment information within 48 hours of this application.
I've read the above and agree.
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FINANCIAL POLICY
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I understand cash is not accepted as a form of payment. All application fees and tuition must be via credit card provided with this application or in the Family Portal. CPYB accepts Visa, MasterCard and Discover.
I understand that it is my responsibility to notify the financial institution due to limits on my account or fraud prevention. I understand that transactions declined for any reason incur a $35 declined transaction fee. ONLY if a letter from the financial institution stating the account was closed due to fraud is provided within 48 hours prior to the payment being processed will the $35 declined transaction fee be waived. Please visit CPYB.org to access the Refund Policy.
I've read the above and agree.
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PAYMENT AND REFUND POLICIES
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I have read, understand and agree to the Refund Policy as outlined at https://cpyb.org/payment-and-refund-policies. I understand there are no exceptions to the Refund Policy and all fees posted and paid through the submission of this application are non-refundable and non-transferable to any student or other CPYB program.
I've read the above and agree.
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PUBLICITY RELEASE
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I hereby authorize CPYB to record the student's picture and voice on photographs, films, live stream, and tapes, to edit these recordings at its discretion, and to incorporate these recordings into movie and sound films on tapes, radio, and television and online broadcast programs. I also give my permission for CPYB to use and license others to use these materials in any manner or media whatsoever. CPYB is permitted to use these materials for publicity, advertising and sales promotion and to use the student's name, likeness, voice and biographic or other information in connection with them. I acknowledge that no promises of compensation were made by CPYB for such use. This release is valid for the duration of the student's enrollment at CPYB.
I've read the above and agree.
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FINANCIALLY RESPONSIBLE PARTY, CUSTODIAL PARENT AND STUDENT
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My electronically typewritten signature below shall be legally binding and serve in the same capacity as my original penned signature.
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Nickname:
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Card Expiration Month: * |
Exp Year: *
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:*
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