Registration
2019 August Course Application: BEGINNING STUDENT

For students who have zero to one year experience in dance or ballet.

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.


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 (Include name, address, phone number, e-mail)*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
How did you hear about CPYB's August Course ? (Please see categories within the instructions)
Does your student have zero to one year of dance/ballet experience? *
Will your student attend both weeks of August Course?*
Will your student attend week one ONLY of August Course?*
 
Additional Information:
 
PROGRAM ACCEPTANCE
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I've read the above and agree.
 
APPLICATION AND TUITION PAYMENT
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I've read the above and agree.
 
FINANCIAL POLICY
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I've read the above and agree.
 
PAYMENT AND REFUND POLICIES
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I've read the above and agree.
 
PUBLICITY RELEASE
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I've read the above and agree.
 
FINANCIALLY RESPONSIBLE PARTY, CUSTODIAL PARENT AND STUDENT
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I've read the above and agree.
 
NO SCHOLARSHIP OR RESIDENTIAL HOUSING AVAILABILITY
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*