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Congratulations! By completing this form, you are officially confirming your child's summer enrollment with Central Pennsylvania Youth Ballet.
You may select one or both of our 2024 Summer Beginning Ballet options:
- 5 Week Summer Beginning Ballet
- August Course Beginning Ballet
If your child has attended a program with CPYB previously, please do not complete this form and contact Admissions at info@cpyb.org.
Please disregard the event start & end dates listed on the form. This is for internal use only.
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Event: |
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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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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 all tuition and fees for the program(s) selected in full to the credit card provided on this form. Summer Beginning Ballet fees are outlined on our website, https://cpyb.org/beginning-ballet/
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 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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Summer 2024 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 summer 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 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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