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Dance Me A Story is for children ages 3 to 6. Students will experience a week of art, dance, and storytelling in an environment that will nurture their love for dance and make believe! This one -week camp is June 12-16, 2017 from 9 a.m. to 12 p.m. Visit CPYB.org for location and dress code information.
Please complete one application per child. 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.
In the student information section, please be sure to include any food allergies.
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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 #5:
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DANCE ME A STORY PAYMENT
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I understand that I will be charged $180 tuition within 5 business days after the 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 $180 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 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
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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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Exp Year: *
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