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Dance Me A Story 2023
Monday, June 12 - Friday, June 16 | 9 am - 12 pm
The contact name must match the billing name, and the emergency contact must be someone other than the parental guardian in the event we cannot reach either parent.
If your child is currently enrolled at CPYB or your child has participated in a previous Dance Me A Story or CPYB program, please contact us BEFORE completing this registration.
For assistance, please contact CPYB at info@cpyb.org.
Dance Me A Story is for children ages 4 to 6. Children must be potty trained.
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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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| 1. How did you hear about Dance Me A Story? (CPYB.org, Facebook, brochure, mailing, referral, dance teacher, other)* | |
| 2. Does your student have food allergies? If YES, please detail in question 2A. The camp will include daily snacks.* | |
| **2A. Please detail your child's food allergy (type, severity, action to be taken in the event of a reaction, etc.) | |
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Additional Information: |
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DANCE ME A STORY SCHEDULE
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I understand that the camp is held at Carlisle Arts Learning Center (CALC) on Monday, June 12 and at the CPYB Studios Tuesday, June 13 - Friday, June 16.
I've read the above and agree.
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DANCE ME A STORY PAYMENT
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I understand that I will be charged $200 tuition upon submission of this form.
I've read the above and agree.
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DECLINED TRANSACTION FEES
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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.
I've read the above and agree.
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REFUND POLICY
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I understand that the Dance Me A Story Camp $200 tuition is non-refundable and non-transferable.
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 any current or future 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.
I've read the above and agree.
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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 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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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Card Expiration Month: * |
Exp Year: *
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Zip:*
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