First Name (Singer)
*
Last Name
*
Gender
*
Female
Male
Other
Prefer not to say
Date of Birth
*
MM
DD
YYYY
Grade for the 2024-2025 School Year
*
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
School Name
*
School District
*
Choir Level for 24-25 based on assessment
*
If you have not yet completed your placement assessment, put your current choir, or unsure.
T-Shirt Size
*
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Who Singer Lives With and Relationship
*
Tuition Payment Plan Option
*
Street Address Line 1
*
Street Address Line 2
Street Address Line 3
City
*
5-Digit Zip
*
Parent or Guardian 1 Name
*
First Name
Last Name
Parent or Guardian 1 Phone
*
(###)
###
####
Parent or Guardian 1 Email
*
Parent or Guardian 1 Workplace
*
Parent or Guardian 2 Name
First Name
Last Name
Parent or Guardian 2 Phone
(###)
###
####
Parent or Guardian 2 Email
Parent or Guardian 2 Workplace
Photo Release
*
I, the undersigned, do hereby consent and agree that Heartland Youth Choir, its employees, or agents have the right to take photographs, videotape, or digital recordings of my child and to use these in any and all media, now or hereafter
known, and exclusively for the purpose of Heartland Youth Choir promotions. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to Heartland Youth Choir, its agents,
and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I
understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement for the minor child.
Handbook Agreement
*
I agree to the terms and conditions in the Heartland Youth Choir Singer Handbook. https://heartlandyouthchoir.org/choir-handbook
First and Last Name
*
Relationship
*
Phone Number
*
(###)
###
####
Preferred Hospital in Event of Emergency
*
Over The Counter Medications Release
*
I hereby give my permission for HYC to administer the following over-the-counter medications to the above-named singer:
Special Health Concerns or Allergies
Please list any special health concerns for this student, including any allergies.
May we contact you about volunteer opportunities that arise throughout the year?
*
Yes
No
Maybe
Please indicate your interests, talents, and/or resources below!
Other Volunteer Opportunities or Connections
Any additional areas of expertise, relationships, or resources you'd be willing to share that is not listed? (i.e. Graphic Design, Tailoring, Photography, Non-Profit Boards, etc...)
How Did You Hear About Us?
*
Family/Friend
School/Virtual Backpack
Advertisement
Social Media
Google/Search Engine
Other
Thank you for submitting your registration!
Tuition can now be paid online! First payment is due on September 1 for full year/Fall Semester or January 15 for Spring Semester.
Heartland Youth Choir is committed to providing an outstanding choral experience to all children and youth in the central Iowa area. It is our goal that no one be denied HYC membership because of financial need. Those with a financial need should complete an Application for Tuition Assistance .
For questions, please contact office@joinhyc.org.