Community Youth Scholarship Placement Day Registration

Thank you for your interest in Community Youth Scholarship Placement Day!

Date: May 1, 2024, 5:30 p.m.

Location: Pittsburgh Ballet Theatre Studios, 2900 Liberty Ave., Pittsburgh  15201

Age: Students must be ages 5 – 9 by Sept. 1, 2024

Attire: fitted, athletic clothing, such as a leotard and tights, or opaque leggings and a t-shirt. Socks or ballet shoes are recommended (no outside shoes or bare feet). Hair should be pulled up and secured away from the face.

Please complete all fields, including income documentation, and let us know if you have any questions at We look forward to seeing you on May 1st!

Community Youth Scholarship Placement Day Registration Form 2024

  • MM slash DD slash YYYY
  • (Student must be between the ages of 5 and 9 years old as of Sept. 1, 2024.)
  • Financial Eligibility

  • For your child to be eligible for the scholarship, your family must be eligible for one of the programs below, or must meet 135% of the income level eligibility for free and reduced-price meals through the National Lunch Program. Please check our website for income levels by household size (please cut and paste into your internet browser): Please indicate below which document you will provide to confirm your eligibility. If possible, please upload your document using the File Upload tab below. Please be sure to black out private information such as social security numbers. Or you may mail or email your document to Lisa Auel, Education Dept., Pittsburgh Ballet Theatre, 2900 Liberty Ave., Pittsburgh, PA 15201; Please submit your documentation PRIOR to the audition.
  • Drop files here or
    Accepted file types: jpg, pdf, png, gif, Max. file size: 128 MB, Max. files: 2.
    • Medical and Media Release

    • By checking "yes" below on behalf of my child, I assume the risk associated with dance instruction / classes and agree that the Pittsburgh Ballet Theatre School (PBTS), Pittsburgh Ballet Theatre (PBT), and its Board of Directors, Faculty, Staff and Volunteers shall not be liable in any way for any injuries sustained or loss of property while attending PBTS or any of its related functions. I hereby grant permission to the Director and /or staff of PBTS to authorize hospital admission and medical, surgical, and emergency treatment, including blood or blood product, transfusions, and diagnostic procedures. Additionally, I grant permission for the administration of anesthesia for the student where medically necessary in case of emergency, accident, and illness, and only in the case that the parent or Family Physician, listed above, cannot be contacted.
    • I do hereby give, grant and assign to Pittsburgh Ballet Theatre, Inc., and its assigns, licensees and legal representatives (“PBT”) the right, consent and permission to use, publish, copy, reproduce, create digitized images of, adapt, distribute, transmit, broadcast, display, modify and otherwise make use of my (or my minor child, as appropriate) appearance, likeness and form in all forms of media and in all manner now known or hereafter to become known, including electronic media and/or composite representations, for advertising, trade, or any other lawful purpose. PBT shall have the right to exercise such rights with my (or my minor child, as appropriate) appearance, likeness and form alone, or with other materials, including, but not limited to, text, data, images, photographs, illustrations, animation, graphics, and video or audio segments of any nature. The rights granted to PBT hereunder are world-wide, irrevocable, perpetual, and assignable. I hereby waive all rights and release PBT and its directors, officers, employees, agents, and independent contractors from, and shall neither sue nor bring any proceeding against any such parties for, any liability, loss, demands, claims, damages or causes of action, whether now known or unknown, for defamation, invasion of right to privacy, publicity or personality or any similar matter, or based upon or relating to the use and exploitation of my (or my minor child, as appropriate) appearance, likeness and form.
    • Students can select one summer camp at Hope Academy for the Arts at East Liberty Presbyterian Church, during the week of June 17 or the week of August 12, 2024 (not required). If you select a summer camp you'll receive more information soon.
    • This field is for validation purposes and should be left unchanged.