Registration
Congratulations! By completing this form, you are officially confirming your student's enrollment in the 2021 BEGINNING August Course Program.

If your dancer has attended a previous CPYB program, please contact info@cpyb.org prior to completing the online registration.
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:
Does the student have at least one year of ballet or dance training?*
If yes, please tell us briefly about their ballet/dance training (school, number of classes per week, etc.)
Student's age at start of program (August 2, 2021).*
BOTH WEEKS (8/2-8/6 AND 8/9-8/13); Tuition = $400.00 (checked=yes)
WEEK 1 ONLY (8/2-8/6); Tuition = $200.00 (checked=yes)
 
Additional Information:
 
CONFIRMING ENROLLMENT IN PROGRAM
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I've read the above and agree.
 
TUITION DUE UPON SUBMISSION
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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
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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:*