Student Summer School Registration Form

Student Information
Student Name:*
First Last
Student Date of Birth:*
MM slash DD slash YYYY
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, .png, or .jpeg
Accepted file types: jpg, png, jpeg, Max. file size: 50 MB.
Second Photograph:*
Image file type must be .jpg, .png, or .jpeg
Accepted file types: jpg, png, jpeg, Max. file size: 50 MB.
Parent/Guardian Information
Parent/Guardian Name*
First Last
Parent/Guardian Phone
Parent/Guardian Email
Housing and Meal Request*
Roomate Request- (If applicable)
Linen Request*
CCA camp attendees will be provided linens (sheets, blankets, and towels) upon request only. If linens are not requested please pack sheets, blankets and towels with camp attendee.
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, 2023.
Student Registration Deposit: $200
Student Registration Deposit:
Note: The $200 registration deposit is non-refundable.
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: 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
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Student Information

Two 4×6 Photographs

Parent/Guardian Information

Summer School Registration Fees:

Summer School

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