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Performing Arts Program ~ Registration Form
Registration may be either faxed (732-842-9323), dropped off at The Count Basie Theatre Box Office, or returned by mail to: Count Basie Theatre, 99 Monmouth Street, Red Bank, NJ 07701
JOIN CBT PERFORMING ARTS ACADEMY ON FACEBOOK!Name _________________________________________ D.O.B ____ Gender m ___ f ___
Address __________________________________________________________
City _______________________ State__________ Zip ________________
Home Phone _________________________ Cell Phone _________________________
Email ___________________________________________
#1 Course Name _______________________________________ Start Date_________ Time____ AM/PM
#2 Course Name _______________________________________ Start Date_________ Time____ AM/PM
#3 Course Name _______________________________________ Start Date_________ Time____ AM/PM
If under 18, parents signature required __________________________________________
Non Re--fundable registration fee: $10.00 per person (please include in payment)
Fees Enclosed _________
Type of payment: Check___ Credit Card___ Visa ___Mastercard ___ American Express ___
Credit Card # ________________________________ Expiration date _________ Sec.No.___
Signature ____________________________ Print name ____________________________
Please note there will be no refunds given after start date of class.
Make check payable to: THE COUNT BASIE THEATRE
Refund Policy: If a student withdraws or cancels registration the following will apply: Course cost will be granted up to 3 weeks prior to the start of class. Refunds minus 10% is granted up to 2 weeks prior to the start of class. Refund minus 25% is granted up to one week prior to start of class. Refund minus 50% is granted if less than 7 days prior to start of class. NO REFUNDS after start of class. Pro-rated refunds will be given at any time during the session for medical emergencies when accompanied by documentation.
