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This application is NOT for students who applied for the 2017 5-Week Summer Ballet Program or are current CPYB Year-Round students.
Applicants can apply for either the full two weeks or week one only. Students cannot apply for week two only. An application must be submitted for EACH student.
PLEASE NOTE: The contact information must match the cardholder name on the credit card. Beginning ballet students will be charged a $35 application fee.
If approved for the 2017 August Course, tuition will be charged to the credit card submitted in this application upon submission.
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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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Additional Information: |
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BEGINNING STUDENT - APPLICATION FEE & TUITION
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I understand upon submission of this form, CPYB will charge a $35 application fee and the applicable tuition payment against the family payment information within this application as all beginners are accepted into the program. If the application is submitted by June 1, tuition is $129 per week. If the application is submitted after June 1 and space is available in the program, tuition is $180 per week.
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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NO SCHOLARSHIP OR RESIDENTIAL HOUSING AVAILABILITY
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I acknowledge there are no scholarship programs for August Course nor provision of residential housing.
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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