TUITION PAYMENT
PLEASE NOTE: Cash is NOT accepted as a form of payment. All payments MUST be via automatic credit card OR bank draft through the Family Portal.
I, the undersigned (Account Holder), hereby certify that the information contained herein is complete and accurate, and agree to pay Central Pennsylvania Youth Ballet (CPYB) for the dance instruction of the above student(s) per the published tuition rates for each student's period of study. Account Holder assumes financial responsibility until CPYB is notified in writing.
Account Holder understands that payment of tuition entitles student(s) to take all available ballet classes scheduled at his/her level or below. No refunds or prorations are given for classes missed due to illness, vacation, school closings, or acts of nature such as inclement weather.
Account Holder hereby fully guarantees and agrees that Account Holder shall be personally responsible, jointly and severally for the payment, by open account acceptance. Account Holder is also responsible for all other damages and costs which may be obligated to CPYB, including expense of collection, suit, or other legal action, actual attorney's and paralegal fees, late or administrative fees, and court costs.
This is intended to be, and shall be construed to be, an absolute, unconditional, present and continuing guaranty of payment. Account Holder agrees and gives full guaranty to be bound by the following Terms and Conditions:
1) Annual registration and security fees for the academic year program are automatically charged to the payer's account and is non-refundable.
2) Summer application fees are automatically charged to the payer's account and are non-refundable.
3) Tuition is due according the Payment Schedule outlined on CPYB.org for the program your student is registered.
4) All accounts must be paid through a credit card automatic charge or bank draft.
5) Any payment returned unpaid for any reason incur a $35 reprocessing fee.
6) Students with delinquent accounts will not be admitted to class or be eligible to register for additional programs until their account is current.
7) Delinquent account balances will be will be processed at the discretion of CPYB.
Account Holder hereby acknowledges that payment can be made by Visa, MasterCard, Discover, American Express, or bank draft.
CREDIT CARD/BANK DRAFT AUTO CHARGE AUTHORIZATION
Tuition fees must be paid by automatic charge with a credit card or bank draft.
CPYB accepts Visa, MasterCard, American Express, and Discover. Balances are due according the Payment Schedule outlined on CPYB.org for the program your student is registered. Any payment returned unpaid for any reason incur a $35 reprocessing fee.
CPYB is authorized to charge my credit card or bank draft for the rental of the studio when my student engages a faculty member of private lessons or participation in on-site health and wellness services, such as massage therapy, physical therapy, or one-on-one conditioning.
CPYB will not sell/give your authorization information to third parties.
REFUND POLICY ACKNOWLEDGEMENT
1. I have read and understand the Refund Policy as outlined on CPYB.org for the program(s) my child is enrolled in. I understand that there will be NO EXCEPTIONS TO THESE REFUND POLICIES.
2. I understand that all the fees posted and paid through the submission of any CPYB form are non-refundable and non-transferable to any student or other CPYB program.
MEDICAL RELEASE Necessary Evaluation or Emergency Care
I hereby give permission to the medical personnel selected by CPYB (including but not limited to physical therapist, trainer, UPMC Carlisle emergency room staff and any consultants that they may deem necessary) to provide assessment, treatment, appropriate diagnostic testing or hospitalization for my child; to release any records necessary for insurance purposes and to provide necessary transportation for health care services. I agree to assume all financial responsibility for medical costs incurred by the student. I give permission for CPYB to contact my child's medical provider for the purpose of confirming medical conditions/treatments or obtaining additional information in order to provide appropriate care. I agree to the best of my knowledge the health history provided in this registration form and the required health form package is correct and complete.
RULES AGREEMENT
I have read and understand the Student Rules as outlined in the Student Handbook and/or on CPYB.org and my child and I agree to abide by them. I understand that failure to do so may result in immediate dismissal from the program with the forfeiture of all fees.
LIABILITY RELEASE
I am aware that dance training and the athletic exercises associated with it place unusual stress on the body and carry the risk of physical injury. On behalf of my child (if under the age of 18) and myself, I assume the risk and agree that CPYB shall not be liable in any way for injuries sustained during attendance at the ballet school or any of its related functions. I also understand that proper ballet training involves physical contact and adjustment of the student's body by the instructor.
PUBLICITY RELEASE
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.
HEALTH/MEDICAL INFORMATION
All students are required to have a completed health/medical history form completed by the start of classes for any CPYB program. A student may not participate in classes until all required health information is on file with CPYB.
FINANCIALLY RESPONSIBLE PARTY, CUSTODIAL PARENT, AND STUDENT
My electronically typewritten signature shall be legally binding and serve in the same capacity as my original penned signature.
