CCA Ballet Festival Student Class Registration Form Please submit one form for each dancer that is registering. Date* MM slash DD slash YYYY Student Name* First Last Parent Name* First Last Parent Email Address* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Teacher Name Student Pre-Registration 3 classes or more (Saturday) Quantity Price: $90.00 Quantity Discount is for a single student registration. It may not be combined with another student's registration. Discount is for one day only and may not be combined over the two day schedule.Student Pre-Registration 3 classes or more (Sunday) Quantity Price: $90.00 Quantity Discount is for a single student registration. It may not be combined with another student's registration. Discount is for one day only and may not be combined over the two day schedule.Check all classes that you will be attending (Saturday) Non-Syllabus I (Sat 9:00-10:25am) Non-Syllabus II (Sat 9:00-10:25am) Non-Syllabus III (Sat 9:00-10:25am) Non-Syllabus IV (Sat 10:30-11:55am) Grade 3 (Sat 10:30-11:55am) Contemporary Level I & II (Sat 10:30-11:55am) Grade I (Sat 12:00-1:25pm) Contemporary III & IV (Sat 12:00-1:25pm) Grade II (Sat 1:30-2:55pm) Non-Syllabus V & Above (Sat 1:30-2:55pm) Contemporary V & Above (Sat 3:00-4:25pm) Grade IV (Sat 3:00-4:25pm) Elementary (V) (Sat 4:30-5:55pm) Intermediate (VI) (Sat 4:30-5:55pm) Advanced (Sat 4:30-5:55pm) Please note if the class you are interested in is not listed, it is filled to capacity and CLOSED to further registrations.Check all classes that you will be attending (Sunday) Non-Syllabus I (Sun 9:00-10:25am) Non-Syllabus II (Sun 9:00-10:25am) Non-Syllabus III (Sun 9:00-10:25am) Non-Syllabus IV (Sun 10:30-11:55am) Grade 3 (Sun 10:30-11:55am) Contemporary Level I & II (Sun 10:30-11:55am) Grade I (Sun 12:00-1:25pm) Contemporary III & IV (Sun 12:00-1:25pm) Grade II (Sun 1:30-2:55pm) Non-Syllabus V & Above (Sun 1:30-2:55pm) Contemporary V & Above (Sun 3:00-4:25pm) Grade IV (Sun 3:00-4:25pm) Elementary (V) (Sun 4:30-5:55pm) Intermediate (VI) (Sun 4:30-5:55pm) Advanced (Sun 4:30-5:55pm) Please note if the class you are interested in is not listed, it is filled to capacity and CLOSED to further registrations.Student Pre-Registration Per Class Fee (Saturday) Quantity Price: $35.00 Quantity Check all classes that you will be attending (Saturday) Non-Syllabus I (Sat 9:00-10:25am) Non-Syllabus II (Sat 9:00-10:25am) Non-Syllabus III (Sat 9:00-10:25am) Non-Syllabus IV (Sat 10:30-11:55am) Grade 3 (Sat 10:30-11:55am) Contemporary Level I & II (Sat 10:30-11:55am) Grade I (Sat 12:00-1:25pm) Contemporary III & IV (Sat 12:00-1:25pm) Grade II (Sat 1:30-2:55pm) Non-Syllabus V & Above (Sat 1:30-2:55pm) Contemporary V & Above (Sat 3:00-4:25pm) Grade IV (Sat 3:00-4:25pm) Elementary (V) (Sat 4:30-5:55pm) Intermediate (VI) (Sat 4:30-5:55pm) Advanced (Sat 4:30-5:55pm) Please note if the class you are interested in is not listed, it is filled to capacity and CLOSED to further registrations.Student Pre-Registration Per Class Fee (Sunday) Quantity Price: $35.00 Quantity Check all classes that you will be attending (Sunday) Non-Syllabus I (Sun 9:00-10:25am) Non-Syllabus II (Sun 9:00-10:25am) Non-Syllabus III (Sun 9:00-10:25am) Non-Syllabus IV (Sun 10:30-11:55am) Grade 3 (Sun 10:30-11:55am) Contemporary Level I & II (Sun 10:30-11:55am) Grade I (Sun 12:00-1:25pm) Contemporary III & IV (Sun 12:00-1:25pm) Grade II (Sun 1:30-2:55pm) Non-Syllabus V & Above (Sun 1:30-2:55pm) Contemporary V & Above (Sun 3:00-4:25pm) Grade IV (Sun 3:00-4:25pm) Elementary (V) (Sun 4:30-5:55pm) Intermediate (VI) (Sun 4:30-5:55pm) Advanced (Sun 4:30-5:55pm) Please note if the class you are interested in is not listed, it is filled to capacity and CLOSED to further registrations.Photo Release* I agree to the statement below. I give permission to the Ceccheti Council of America to photograph or video my child (if under 18) during the EMC Ballet Day. It is understood that the photographs or promotional videos could be used for publicity and advertising purposes for the CCA now and in the future.Total $0.00 This amount will be charged to your credit card for this transaction.Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. Δ
