Central Pennsylvania Youth Ballet Online Registration

Registration

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Registration for NEW* students. If your child has previously attended a CPYB program, please contact us at info@cpyb.org for registration instructions.

*New students ages 10-19 must first audition and receive an invitation to register.

2024-2025 Registration Opens March 15, 2024

Questions? Please contact CPYB Admissions at info@cpyb.org.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact (Include name, address, phone number, e-mail)*

Health Insurance Carrier, Policy Holder Name and Policy Number*

Contact #1

Billing Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work # *

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work # *

Cell # * Receive Text Message Notifications

Email* (Emails are kept confidential)

Confirm Email*

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #* Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

Academic School District*

Physical Limitations

Special Needs (Leave blank if NONE)

Allergies (If none, enter N/A)*

Medications (Leave blank if NONE)

Date of Most Recent Physical*

Previous Ballet Training?*

Previous Ballet Training cont.

After clicking on SELECT CLASS* , press SEARCH. On the pop-up screen make your selection based on the below criteria.

New students age 10+, follow instructions in invitation email following your audition.

New students age 6-9 years old, select "AY2024-2025 Primary/Pre-Professional - Registration"

New students age 5 years old by Sept 1, select "AY2024-2025 Pre-Ballet - Registration"

New students ages 3-4 years old by Sept 1, select one class only:
"AY2024-2025 Creative Movement (WED) - Registration"
"AY2024-2025 Creative Movement (SAT) - Registration"

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #* Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

Academic School District*

Physical Limitations

Special Needs (Leave blank if NONE)

Allergies (If none, enter N/A)*

Medications (Leave blank if NONE)

Date of Most Recent Physical*

Previous Ballet Training?*

Previous Ballet Training cont.

After clicking on SELECT CLASS* , press SEARCH. On the pop-up screen make your selection based on the below criteria.

New students age 10+, follow instructions in invitation email following your audition.

New students age 6-9 years old, select "AY2024-2025 Primary/Pre-Professional - Registration"

New students age 5 years old by Sept 1, select "AY2024-2025 Pre-Ballet - Registration"

New students ages 3-4 years old by Sept 1, select one class only:
"AY2024-2025 Creative Movement (WED) - Registration"
"AY2024-2025 Creative Movement (SAT) - Registration"

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #* Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

Academic School District*

Physical Limitations

Special Needs (Leave blank if NONE)

Allergies (If none, enter N/A)*

Medications (Leave blank if NONE)

Date of Most Recent Physical*

Previous Ballet Training?*

Previous Ballet Training cont.

After clicking on SELECT CLASS* , press SEARCH. On the pop-up screen make your selection based on the below criteria.

New students age 10+, follow instructions in invitation email following your audition.

New students age 6-9 years old, select "AY2024-2025 Primary/Pre-Professional - Registration"

New students age 5 years old by Sept 1, select "AY2024-2025 Pre-Ballet - Registration"

New students ages 3-4 years old by Sept 1, select one class only:
"AY2024-2025 Creative Movement (WED) - Registration"
"AY2024-2025 Creative Movement (SAT) - Registration"

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #* Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

Academic School District*

Physical Limitations

Special Needs (Leave blank if NONE)

Allergies (If none, enter N/A)*

Medications (Leave blank if NONE)

Date of Most Recent Physical*

Previous Ballet Training?*

Previous Ballet Training cont.

After clicking on SELECT CLASS* , press SEARCH. On the pop-up screen make your selection based on the below criteria.

New students age 10+, follow instructions in invitation email following your audition.

New students age 6-9 years old, select "AY2024-2025 Primary/Pre-Professional - Registration"

New students age 5 years old by Sept 1, select "AY2024-2025 Pre-Ballet - Registration"

New students ages 3-4 years old by Sept 1, select one class only:
"AY2024-2025 Creative Movement (WED) - Registration"
"AY2024-2025 Creative Movement (SAT) - Registration"

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #* Receive Text Message Notifications

Additional Info

Student Email

T-Shirt Size

Academic School District*

Physical Limitations

Special Needs (Leave blank if NONE)

Allergies (If none, enter N/A)*

Medications (Leave blank if NONE)

Date of Most Recent Physical*

Previous Ballet Training?*

Previous Ballet Training cont.

After clicking on SELECT CLASS* , press SEARCH. On the pop-up screen make your selection based on the below criteria.

New students age 10+, follow instructions in invitation email following your audition.

New students age 6-9 years old, select "AY2024-2025 Primary/Pre-Professional - Registration"

New students age 5 years old by Sept 1, select "AY2024-2025 Pre-Ballet - Registration"

New students ages 3-4 years old by Sept 1, select one class only:
"AY2024-2025 Creative Movement (WED) - Registration"
"AY2024-2025 Creative Movement (SAT) - Registration"

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

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