2020 5-Week Summer Ballet Program Application: BEGINNING BALLET

One application per student only. Application instructions are available on

NEW students should complete this form in it's entirety.

RETURNING students (those who attended or applied for a 2017-2019 CPYB summer program), click on the red link above to login to your Family Portal BEFORE completing this form for your existing account to be recognized. Please contact CPYB at 717.601.2840 if you need assistance with your username and password. Again, one application per student only.

Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
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
Does the student have at least one year of ballet training?*
Student's age.*
Do you have a promo code? Enter it HERE!
Additional Information:
I understand all beginning ballet students are accepted into the program immediately upon application (if space allows).
I've read the above and agree.
I understand upon submission of this form, CPYB will charge a $35 application fee, a $55 security fee and the $550 tuition against the payment information in my Family Portal within 48 hours of this application.
I've read the above and agree.
I understand cash is not accepted as a form of payment. All application fees 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 my financial institution due to limits on my account or fraud prevention. I understand transactions declined for any reason incur a $35 decline 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 to access the Refund Policy.

I've read the above and agree.
I have read, understand and agree to the Refund Policy as outlined at 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.
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.
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.
Enter your Full Name: *   
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*