YPC National Lab - Chorister Registration

YPC National Lab Chorister Registration Form 2023

Step 1 of 7

Chorister Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone(Required)

Home Phone(Required)

Email(Required)

Gender(Required)

2022 - 2023 Grade(Required)

Name of Chorus/Choir(Required)

City and State of Chorus(Required)

Conductor(Required)

Conductor Email(Required)

Conductor Phone(Required)

Voice Part(Required)

T-shirt Size(Required)

Ethnicity (Optional)

Parent/Guardian Contact Information

Parent/Guardian #1

Parent/Guardian #2

Name(Required)

Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone(Required)

Mobile Phone

Email(Required)

Health & Emergency Information

Full Name(Required)

Date of Birth(Required)

Emergency Contact Name(Required)

Phone(Required)

Relation(Required)

Physician(Required)

Physician Phone(Required)

Physician Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have Medical Insurance?(Required)

Yes

Insurance Company

Phone

Claim Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Subscriber Name

Subscriber #

Group #

Subscriber Employer

Please upload a picture of the front and back of your insurance Card

Drop files here or

Max. file size: 16 MB.

IN CASE OF MEDICAL OR SURGICAL NECESSITY OR EMERGENCY I UNDERSTAND THAT YPC NATIONAL WILL MAKE EVERY EFFORT TO REACH MYSELF (US) OR THE EMERGENCY CONTACT REGARDING MEDICAL TREATMENT. IN THE EVENT THAT I (WE) AM (ARE) NOT AVAILABLE, I (WE) HEREBY GIVE MY (OUR) PERMISSION TO THE PHYSICIAN SELECTED BY YPC NATIONAL STAFF TO PROVIDE WHATEVER MEDICAL OR SURGICAL TREATMENT IS NECESSARY. I (WE) AGREE TO ASSUME RESPONSIBILITY FOR ALL COSTS ADVANCED BY YPC NATIONAL OR INCURRED IN ORDER TO OBTAIN MEDICAL CARE FOR MY (OUR) CHILD. I (WE) AGREE TO BE RESPONSIBLE FOR ANY COSTS RELATED TO HIS/HER RETURN TRIP HOME. I (WE) UNDERSTAND THAT SUCH A DECISION IS SOLELY AT THE DISCRETION OF THE ADULT REPRESENTATIVES OF YPC NATIONAL. I (WE) AGREE TO THE DISCLOSURE OF HEALTH INFORMATION INCLUDED IN THIS REGISTRATION TO PERSONS OR INSTITUTIONS AT THE DISCRETION AND AS DEEMED NECESSARY BY THE YPC NATIONAL STAFF TO OBTAIN MEDICAL TREATMENT FOR MY (OUR) CHILD.

THE HEALTH HISTORY IS CORRECT, AND PARTICIPANT HAS PERMISSION TO ENGAGE IN ALL PRESCRIBED ACTIVITIES AS NOTED.

Print Name:(Required)

Signature(Required)

Date(Required)

Permission, Release and Waiver

I consent to the use of my image, voice, pronouncements, likeness and name as well as all biographical material submitted by me to YPC National and the Young People’s Chorus of New York City (YPC) whether used in excerpts or in full, in, without limitation, publications, film, videotapes, audio tapes, television, theatrical performances, social media, internet web casts and all forms of present or future electronic media, broadcasting and reproduction means, and for any purpose including without limitation, advertising and promotion of YPC National, YPC, and other non-commercial and commercial organizations, so long as such use is approved by the YPC National and YPC staff.

I agree to assume responsibility for all costs, both legal and reparation, resulting from damage to property and/or belongings of YPC National, YPC, Lee University, or individuals associated or not associated with the YPC National Studio determined to be caused by me during the time I am in attendance at the 2023 YPC National Choral Lab held July 18-23, 2023.

In return for YPC National allowing me to participate in concerts, practices, rehearsals and other events or activities, I hereby release and hold harmless YPC National, YPC, its officers, directors, staff and volunteers from any and all claims, demands, damages, liabilities, costs and expenses which I, or my heirs or representatives may have against YPC National, YPC, its officers, directors, staff and volunteers for personal injuries, property damage or other loss or damage of any kind whatsoever, whether or not presently, or may hereafter have, known or unknown, which may arise out of or relate in any way to any YPC National and YPC activity.

I understand that participation in YPC National, YPC, and its concerts and activities is voluntary and at my election and choice and that YPC National and YPC are not-for–profit corporations.

I acknowledge having read this release and understanding all of its terms and their significance, state that this release is signed and delivered voluntarily.

Date(Required)

Name(Required)

First Last

Signature(Required)

Chorister Registration Fee - $1,350

YPC National Lab fees include:

- Housing, meals, and snacks
- All local transportation
- Excursions
- Music and materials
- T-shirt

Registration Fee(Required)

Price:

Credit Card Transaction Fees

Price:

Total

Payment Options(Required)

Credit Card

Check

*Please note that an additional 3.5% transaction fee will be applied to your payment. In order to avoid this fee, please pay by check.

*Please submit check to: YPC National 37 West 65th Street, 2nd Floor New York, NY 10023. *If choosing this payment option, registration for YPC National is pending receipt of your check.

Credit Card

Card Details

Cardholder Name

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address for Receipt

YPC National Lab – Chorister Registration