Intersession 2026 Registration Only

Intersession 2026 Registration Only

Central Pennsylvania Dance Workshop
- Full Name*
  
  First NameLast Name
- She/her/hersHe/him/hisThey/them/their
- Local Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- YesNo
- Permanent Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- New StudentReturning Student
- How did you learn about CPDW?
- Why did you choose CPDW?
- What do you hope to gain from your class experience?
- Student E-mail*
- Contact Number*
  
  Area CodePhone Number
- Child/under 18Adult/over 18
- Birthdate*
  
  MonthDayYear
  Date
- Grade
- Parent/Guardian #1
- Name*
  
  First NameLast Name
- Relationship
- Email*
  This email will receive a form submission confirmation
- Phone Number*
  
  Area CodePhone Number
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian #2
- Name
  
  First NameLast Name
- Relationship
- Email
  example@example.com
- Phone Number
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian #1
- Parent/Guardian #2
- Emergency Contact*
- #141 Children's Creative Movement, Sa 9:00a - 9:45a*#161 Children's PreBallet, Sa 9:50a - 10:35a*#200 Children's Beginning Ballet, W 4:00p - 5:00p*#201 Children's Beginning Ballet, Sa 10:40a - 11:40a*#230 Children's Intermediate Ballet, T/TH 4:50p - 6:00p#250 Children's Advanced Ballet, T/TH 6:00p - 7:15p#320 Pointe, Sa 11:45a - 12:40p#350 Children's Modern, Sa 12:45p - 1:55p*#400 Children's Jazz, W 5:05p - 6:00p*#430 Children's Lyrical, M 4:50p - 6:00p*#470 Children's Beginning Tap, TH 4:00p - 4:45p*#475 Children's Int Tap, M 4:00-4:45*#480 Children's Adv Tap, W 8:50p - 9:35p*#490 Children's Musical Theatre Dance, T 4:00p - 4:45p*#500 Adult Beginning Ballet, M/W 7:35p - 8:45p#501 Adult Beginning Ballet Workout, M/W 10:30a - 11:45a#530 Adult Intermediate/Advanced Ballet, M/W 6:05p - 7:30p#620 Adult Pointe, Sa 11:45a - 12:40p#830 Adult Lyrical/Jazz, T/TH 7:50p - 9:00p#870 Adult Beginning/Intermediate Tap, M 8:50p - 9:35p*#875 Adult Advanced, W 8:50p - 9:35p*#890 Adult Hip Hop, T/TH 8:35p - 9:20p
- 4 classes $56.00 *for marked classes only8 classes $112.0012 classes $162.0016 classes $216.00Single class $15.00
- Additional Requests
- RELEASE FROM LIABILITY: It is expressly agreed that all exercise, training dancing, participation in classes, and the use of facilities of the Central Pennsylvania Dance Workshop by students is undertaken at the sole risk of students or parents/guardians of minor students. Students and parents/guardians of minor students hereby agree to hold the Central Pennsylvania Dance Workshop harmless, releasing forever its employees, owners, operators, agents, servants, advisors, and assignees from any and all claims for injury, illness, and/or property damage.
- FINANCIAL POLICY: A minimum deposit on one-half of the total tuition is required at registration. The remainder is due by the semester drop date. Any student who must be billed for tuition will be charged a carrying charge of $5.00 per month, or any part of a month. Payment plans are available for students who need them, particularly students registering for more than one class.
  
  To officially drop a class, the student (or parent) must submit a signed withdrawal slip to the office on or before the drop date. The $25 registration fee, $10 insurance fee, and per class charge for each class which has already met will be deducted from the amount paid, and the remainer will be issued as a refund.
  
  Any student who does not officially withdraw from class by the drop date is financially responsible for the full amount of tuition registered, whether classes are attending or not.
- PHOTO RELEASE: I give CPDW permission to use images of me or my child taken during DPDW activities in CPDW-related publications, including website and social media. I understand that CPDW will not identify individuals by name in any publications nor tag individuals on any social media.
- I grant permissionI do not grant permission
- Signature*
- Date*
  
  MonthDayYear
  Date
- Should be Empty: