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A 5-Week Summer Ballet Program (5WSBP) application must be submitted for EACH individual beginning ballet student within a family, using the same contact information.
Please be sure to read the INSTRUCTIONS on CPYB.org for entry of each question. The contact name must match the cardholder name on the credit card.
Upon submission of this application, a $35 application fee and the tuition will be posted and charged within 48 hours to the credit card documented within the application form. All the fees posted and paid through the submission of this form are non-refundable and non-transferable to any student or other CPYB program.
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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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APPLICATION PROCESSING
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I understand all beginning ballet students are accepted into the program immediately upon application.
I've read the above and agree.
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REGISTRATION AND TUITION PAYMENT
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I understand upon submission of this form, CPYB will charge a $35 application fee and the tuition payment against the family payment information within this application. If the application is submitted by May 1, tuition for beginning ballet is $270. If the application is submitted after May 1 and space is available in the program, tuition for beginning ballet is $305.
I've read the above and agree.
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APPLICATION PAYMENT
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I understand cash is NOT accepted as a form of payment. All application fees MUST be via credit card. CPYB accepts Visa, MasterCard and Discover.
I've read the above and agree.
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DECLINED TRANSACTIONS
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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. Please visit the tuition page on CPYB.org to access the Refund Policy.
I've read the above and agree.
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PAYMENT AND REFUND POLICIES
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1. I have read and understand the Refund Policy as outlined on CPYB.org. 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 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 Central Pennsylvania Youth Ballet (CPYB) to record the student's picture and voice on photographs, films, and tapes, to edit these recordings at its discretion, and to incorporate these recordings into movie and sound films on tapes, radio, or television 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.
If I do not agree with the above, I must state so in the comment section below.
I've read the above and agree.
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FINANCIALLY RESPONSIBLE PARTY, CUSTODIAL PARENT AND STUDENT
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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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