Heartland Chamber Music Ltd · Jr. Festival - Concertmaster or Principal Cello

Contact Information

Name

*

First Name

Last Name

Email (Will be used for Festival Communication

*

Additional Email

*

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Instrument

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How old will you be on July 29, 2022

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In lieu of live auditions this year, we ask students to submit audition recordings. Auditions should be submitted via weblinks from YouTube, Vimeo, Dropbox, or Google Drive. Video recording must be received by May 30, 2022. Weblinks can be submitted below

Home Phone

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Mobile Phone

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Parent Name (required if under 18)

First Name

Last Name

Parent Name

First Name

Last Name

Parent's Place or Employment

School Attending

*

Music School Instructor's Name

First Name

Last Name

Music School Instructor's Email

Private Music Instructor

*

First Name

Last Name

Private Music Instructor's Email

Please list the name of anyone who referred you

First Name

Last Name

PROMO CODE FROM A FRIEND

Please tell us a little about your chamber music background

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Gender

*

Male

Female

Transgender

Non Binary/Non Conforming

Prefer Not to Say

Are You Hispanic or Latino

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Yes

No

Prefer Not to Say

Regardless of your answer to the previous questions, please check one or more of the following groups which you consider yourself to be a member.

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American Indian or Alaska Native

Asian

Black/African American

Native Hawaiian or other Pacific Islander

White

Prefer Not to Answer

How did you hear about the Festival (Check all that apply)

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E-Mail from HCM

Facebook

Instagram

Mailer

Friends

School Music Instructor

Private Music Instructor

Other

Birth Date

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(mm/dd/yyyy)

T-Shirt Size

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Have you participated in the HCM Festival before?

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Yes

No

If Yes to participating how many years have you participated?

We need parent volunteers to help with lunch supervision, providing snacks, set up and clean up. Can we contact you to volunteer?

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Yes

No

Will you need a lodging referral for the Festival? (You must be 16 or over to stay without a chaperone)

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Yes

No

Maybe

HEARTLAND CHAMBER MUSIC HOLD HARMLESS AGREEMENT

By completing and submitting this form, I, STUDENT OR PARENT, hereby release Heartland Chamber Music, Ltd, its employees and agents, from any claims for damages from personal injury to MUSICIAN or loss of property; and authorize the employees and agents of Heartland Chamber Music to obtain medical care for MUSICIAN in the event of an emergency, including transportation by ambulance. I understand that Heartland Chamber Music does not guarantee an allergy-free environment and that the request for personal allergy information is solely for informational purposes in the event an emergency situation occurs. I indemnify Heartland Chamber Music for the costs of medical care or other damages arising from MUSICIAN participating in Heartland Chamber Music programming. Heartland Chamber Music Communication Policy: 1) Heartland Chamber Music reserves the right to audio and/or video record and/or photograph any and all activities for later use which may include printed or electronic materials and/or radio/television/online broadcast. 2) Musician and/or Parent likeness, either in print, electronically or in audio or video recordings, may be used for any purpose, with or without the use of name, school, grade and other pertinent information, and without remuneration, by Heartland Chamber Music and its assigns for the purpose of internal and external communications. Parents/students are responsible for any/all transportation to and from rehearsals and concerts. By completing and submitting this form you are confirming that you are a parent/legal guardian of the student and that you have read and understand the Hold Harmless Agreement.

I have read and agree to the Hold Harmless

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Yes

No

Student Name or Parent Name if under 18

*

First Name

Last Name

Communication Policy

Heartland Chamber Music Communication Policy: 1) Heartland Chamber Music reserves the right to audio and/or video record and/or photograph any and all activities for later use which may include printed or electronic materials and/or radio/television/online broadcast. 2) Musician and/or Parent likeness, either in print, electronically or in audio or video recordings, may be used for any purpose, with or without the use of name, school, grade and other pertinent information, and without remuneration, by Heartland Chamber Music and its assigns for the purpose of internal and external communications. Parents/students are responsible for any/all transportation to and from rehearsals and concerts. By completing and submitting this form you are confirming that you are the student or a parent/legal guardian of the student and that you have read and understand the HCM Communication Policy.

I have read and agree to the Communication Policy

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Yes

No

Student Name or Parent Name if under 18

*

First Name

Last Name

Carpool Policy

Camerata and Festival Scholars may travel to Lawrence, KS to perform live on KPR on Thursday, Aug. 4 and will need to have transportation to this event. If a student is under the age of 18 they must either be transported by a parent or guardian, or sign this release in order to carpool with faculty and/or other adult participants before Thursday morning. To participate in a carpool arrangement, parent(s) and/or natural guardian(s) are required to complete and submit this form prior to the start of a carpool arrangement. If there are ANY changes, it is the responsibility of the parent or guardian to re-submit this form to the Heartland Chamber Music (HCM). If any carpool arrangement is to be terminated, the parent must notify HCM by providing a written and dated withdrawal of consent. In consideration of the benefits that the undersigned and my/our child will receive as participants in a carpool arrangement, I/we, individually and on behalf of my/our child assume all risks and waive any liability of any nature whatsoever against HCM, with respect to any and all actions, claims, or demands (including attorney’s fees) that may accrue or be made or be brought by the undersigned, said child, or someone on behalf of said child, against HCM, which arise out of our in connection with my child’s participation in ANY carpool arrangement, whether such claim, demand or action is the result of the negligence of carpool participants or otherwise. I understand that HCM does not check drivers’ license validity, verify insurance coverage or run background checks for carpool participants. I/we hereby release, waive, forever discharge HCM from any and all claims, demands, damages to or loss or destruction of any property, or claims or damages that result from loss of life, which the undersigned, or said child may suffer while participating in ANY carpool arrangement or arising out of our connection with such participation, whether such claims, demands, or damages are the result of the negligence of carpool participants or otherwise. By completing and submitting this form you are confirming that you are a parent/legal guardian of the student and that you have read and understand the HCM Carpool Release.

I have read and understand the Carpool Policy

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Yes

No

Student Name or Parent/Legal Guardian for students under 18

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First Name

Last Name

JCCC Code of Conduct

JCCC Student Code of Conduct Policy 319.01. Any student enrolled at JCCC is expected to conduct themselves as responsible individuals at all times while participating in any course or College activity or event. JCCC reserves the right to request that a student be removed from the Festival if the expected Code of Conduct is violated, in which case no refund will be given to that student. The policy: http://www.jccc.edu/about/leadership-governance/policies/students/student-code-of-conduct/student-code-conduct.html. By completing and submitting this form you are confirming that you are a parent/legal guardian of the student and that you have read and understand the JCCC Code of Conduct Policy.

I have read and will abide by the JCCC Code of Conduct

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Yes

No

Student Name or Parent if student is under 18

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First Name

Last Name

Health Guidelines

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As we work to keep students and faculty safe, please know we will follow the CDC Guidelines for gathering and performing at all times which may include the wearing of face masks, social distancing, and hand sanitizing. I hearby agree to follow all such guidelines that may be in effect by the CDC, local health authorities or Johnson County Community College

Yes

No