HYC Student Information and Release

Please complete the following information for EACH student enrolled in an HYC Madison County Satellite ensemble.

Student Information

Shirt Size

Parent Information

Transportation - CANTILENA ONLY!

Emergency Contact

Photo Release

I, the undersigned, do hereby consent and agree that Heartland Youth Choir and Madison County Music Co., 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 and Madison County Music Co. 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 and Madison County Music Co., 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.