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Congratulations! By completing this form, you are officially confirming your student's enrollment in the 2022 5-Week Summer Ballet Program - BEGINNING LEVEL A.
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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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ALL FEES DUE UPON SUBMISSION
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I understand that upon submission of this form, CPYB will charge a $35 registration fee, a $60 security & technology fee and $550 tuition in full to credit card provided on this form.
I've read the above and agree.
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PAYMENT AND REFUND POLICIES
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I have read and understand the Payment and Refund Policies as outlined at https://cpyb.org/beginning-ballet/. I understand there are no exceptions to these policies and that all fees posted and paid through submission of this form 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 and 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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Summer 2022 COVID-19 Student Agreement
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Central Pennsylvania Youth Ballet (CPYB) prioritizes the health and safety of our students, faculty, and staff. To successfully create the safest environment possible, a commitment to CPYB guidelines and protocols is imperative. Anyone taking unnecessary risks and failing to adhere to these expectations is taking such risk not only on their own behalf, but also on behalf of the entire CPYB 5-Week Summer Ballet Program.
While CPYB will continue to operate with rigorous health and safety guidelines in place, our plans and protocols will continue to evolve and are dependent upon the progress of the pandemic and updates to public health regulations and policies. All programs are subject to change. COVID -19 vaccines are encouraged but not required for those who are age-eligible.
*As of December 1, 2021.
I've read the above and agree.
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FINANCIALLY RESPONSIBLE PARTY
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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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