Student Summer School Registration Form

Student Information
Student Name:*
First Last
Student Date of Birth:*
Date Format: 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 or .png
Accepted file types: jpg, png.
Second Photograph:*
Image file type must be .jpg or .png
Accepted file types: jpg, 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 Summer School Registration Form

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 EMC Ballet Day & Teacher Refresher