2023-2024 REGISTRATION FORM

2023-2024 REGISTRATION FORM
Every applicant must complete registration form below and return to the Hispanic Cultural Center of Midland (HCCM)

"A Company of Arts' P.O. Box 51404, Midland, TX 79710-1404

YEARLY MEMBERSHIP FEE: $50.00 per family (Fee is due at registration)
CHILD'S NAME
DATE OF BIRTH
AGE
SEX: Male/Female
GRADE
SCHOOL Presently Attending
HOME

STREET ADDRESS

Street Address Line 2

CityState / Province

ZIP CODE
HOME PHONE
OTHER

ADDRESS

Street Address Line 2

CityState / Province

ZIP CODE
HOME PHONE
CELL PHONE
EMAIL
FATHERS NAME
WORK PHONE
MOTHER'S NAME
WORK PHONE
In signing below, I have indicated that the above student has my permission to participate in the above named organization, and 1 hereby waive the HCCM from any and all liability, other than gross negligence with willful misconduct of the HCCM.

ALL ARTS WILL BE OF HISPANIC ORIGIN: Mexican, Latino, Cuban, Spanish, Puerto Rican etc.
Received Rules & Regulations

YES

Street Address Line 2

CityState / Province

NO
DATE
MONTH/DAY/YEAR
SIGNATURE
Parent/Guardian
EDUCATION OF THE ARTS BY CATEGORIES:
[LIMITED ENROLLMENT Due to space; Classes must have 15 students to make a class.]

All students must maintain a cumulative 2.5 Grade Point Average. Student will be asked to bring a copy of their report cards at the end of each 6 weeks.
PLEASE CHOOSE ONE

DanceMariachiArt
HCCM "A Company of Arts" PLEDGE

We pledge to be the best we can be: to be feam players to respect the rules, opponents, officials, and each other, and improve ourselves in girl mind, and body.

Enrollment is Limited
PAYMENT SCHEDULE

Yearly Family Membership ... $50.00... Due at registration. Yearly dues for ballet program...$240.00...Due at registration or quarterly charge per child...$60.00... July, Oct., Jan., April.

PURCHASE HERE (Convenience fee added to payment)

Family MembershipDue at registration annually

$51.75 Quantity

Mariachi/Ballet ProgramYearly Payment

$248.40 Quantity

Mariachi/Ballet ProgramQuarterly Payments

$62.10 Quantity

Total

$0.00

Credit Card

I (Parent/Guardian)....
PARENT OF...
STUDENTS NAME
PERMISSION (choose one)

Give permission to HCCM to use my child's picture for promotions & advertising.Don't give permission to HCCM to use my child's picture for promotions & advertising
HISPANIC CULTURAL CENTER OF MIDLAND - "A Company of Arts"

The mission of the Hispanic Cultural Center of Midland is to preserve the Hispanic culture through the education of arts, for the youth of the community. This will enhance the quality of life within the community by creating artistic educational opportunities for a child's development and dreams, while building a child's positive attitude toward one's discipline, telf-esteem, and pride in a multi-cultural group, thus promoting cultural proficiency Programs with specific objectives, strategies, and outcomes will reflect the unique relationship that exists between the Hispanic Cultural Center of Midland and the children it serves. For more information please call: Hispanic Cultural Center of Midland, Executive Director Office 432.683-4226 Fax 432.683.4426

MISD is not responsible for and does not endorse the contents of any non-scheol Aterature that may be distributed on Midland ISD campuses as a service to students, fomilies and employees.
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2023-2024 REGISTRATION FORM

EDUCATION OF THE ARTS BY CATEGORIES:

PAYMENT SCHEDULE

Credit Card