Student Summer School Registration Form

Student Information

Student Name:*

First Last

Student Date of Birth:*

Student Phone:

Student Email:

Student Address:*

Street Address City State / Province / Region ZIP / Postal Code

Years Training:

How many years of serious training have you completed?
*Note: please enter numbers only (e.g. 10)

Ballet Classes per Week:

How many ballet classes are you currently taking per week?
*Note: please enter numbers only (e.g. 4)

Most Recent CCA Exam Passed:

Sponsoring Teacher:

First Last

Sponsoring Teacher Phone:

CCA Scholarship Recipient

Two 4×6 Photographs

Two 4×6 photographs in solid colored leotard and pink tights must accompany application. Photographs must show two poses: tendu a terre to the second position (arms in second) and first arabesque. To avoid complications when submitting your application, please upload photos in the smallest size possible.

First Photograph:*

Image file type must be .jpg or .png

Second Photograph:*

Image file type must be .jpg or .png

Parent/Guardian Information

Parent/Guardian Name*

First Last

Parent/Guardian Phone

Parent/Guardian Email

Housing and Meal Request

Roomate Request- (If applicable)

Summer School Registration Fees:

Note: Your Credit Card will be charged $200, once you submit this form. If you are accepted into our two-week summer intensive student program, you will be notified via email. You will also receive a registration package and invoice via regular mail. The remaining balance is due before June 1st, 2018.

Student Registration Deposit: $200

Student Registration Deposit:

Note: The $200 registration deposit is non-refundable.

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Credit Card Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Student Information

Two 4×6 Photographs

Parent/Guardian Information

Summer School Registration Fees:

Summer School

Remy Young-Corps de Ballet American Ballet Theatre

CCA Eastern Michigan Committee Exam Session

CCA Colorado Committee Liaison Weekend