Student's  Name:__________________________________________________________

Student's  Date of birth___________________ Age:______________________________

Address:________________________________________________________________

City,  State,  Zip:__________________________________________________________ 

Email:__________________________________________________________________

Telephone:______________________________________________________________

Additional or Cell Phone:___________________________________________________

Fax:___________________________________________________________________

How did you hear about CMYB?______________________________________________

______________________________________________________________________

Class/Level_____________________________________________________________

Day/Time_____________________ Amount due:_______________________________

COLUMBIA GYM (Clarksville):                            Make checks payable to:  CMYB

SLAYTON HOUSE / NANTUCKET CENTER:    Make checks payable to:  CMYB

Release of Liability:

I, the adult applicant or I, the parent or legal guardian of the enrolling student listed herein, hereby give approval of the applicant's participation in any and all Central Maryland Youth Ballet programs and activities for which they are registered and assume the risks associated with those activities, and agree to pay tuition in a regular and timely fashion. I waive, release, absolve, indemnify and agree to hold harmless CMYB, it's directors, faculty, contracted instructors, participants, school locations (Slayton House, Nantucket Center, Columbia Gym) and persons involved in the operation of Central Maryland Youth Ballet's programs for any claims, demands or causes of action which are in any way connected with, or may arise from the participation of the applicant in these activities, including but not limited to any injury or other loss to named applicant or any member of his/her family whether as a participant in the activities or as a spectator. 

 I have read and agree to this release.

I also give permission for Central Maryland Youth Ballet to take photos and/or video of me or my child to use for the web site and for purposes of promoting the school.

Student's Name (Please Print):______________________________________

Student's Signature:_____________________________Date:_____________

Parent/Guardian Name (Please Print):_______________________________

Parent/Guardian Signature:_______________________Date:____________

Refund Policy:
  $10 processing fee for refunds before first class has met.  No refunds after first class has met.  $30 charge for returned checks.  No exceptions.

                     Late registrations are welcome.