2024 Summer Singers Registration Form

2024 Summer Singers Camp Registration
Dates: June 24-28, 2024

Venue: Duquesne University

Ages: 7-10

Price: $350 (Tuition Assistance Available- please fill out this form if needed)
Singer Information
Singer's Name *

First NameLast Name
Birth Date*

MonthDayYear
Grade*
School Name for 2024-2025 school year*
If homeschooled, please write "Homeschool."
Singer's School District for 2024-2025 school year:*
If homeschooled or attending private school, please list school district of residence.
Is this singer currently enrolled in a PYC choir?*

YesNo
Has this singer previously participated in any PYC programming? Please check all that apply.*

No prior involvement with PYCNeighborhood Training ChoirPYC Core ChoirsSummer Singers CampSinging SaturdayOther
Singer's Gender:
Please note this question is optional.
Singer's Pronouns:
(e.g. she/her, he/him, they/them, etc.). Please note this question is optional.
Gender

MaleFemaleNon-BinaryTransgenderIntersexPrefer not to sayOther
Pronouns

He/Him/HisShe/Her/HersThey/Them/TheirsOther
Singer's Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PYC strives to create programs that are accessible and relevant to the many cultural backgrounds represented in the population of the Pittsburgh region. Knowing how our students self-identify with respect to their racial/ethnic background helps us measure how we are doing. Please check all that apply, or check "I prefer not to answer" if you would rather not disclose this information.*

African-American or BlackAmerican Indian or Alaska NativeAsian or Asian IndianCaucasian/WhiteHispanic, LatinX, or Spanish originMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderI prefer not to answer.Other
How did you learn about PYC? (please check all that apply)*

From a friend or former PYC singerFrom a music teacherAt a community festival or fairMagazine article or advertisementNewspaper articleWitnessed a PYC performance in the communityOnline SearchFacebookInstagramSinging SaturdayNeighborhood Training ChoirOther
Name of referring PYC singer or music teacher (if applicable):
Parent/Guardian Information
Primary Parent/Guardian Name*

First NameLast Name
Relationship to Singer*
Primary Parent/Guardian Cell Phone Number*
Primary Parent/Guardian E-mail*
example@example.com
Emergency Information
Singer's Emergency Contact Name*

First NameLast Name
Relationship to Singer*
Phone Number*
Alt. Phone Number*
Does the singer have any allergies, chronic illness, or medical conditions? If yes, please describe.
Does the singer currently work with an IEP or a 504 Service Agreement in their school placement? If so, please share that pertinent information with PYC staff so we can offer the best camp experience for your singer.
Are there any other requested accommodations or support for the singer?
Is the singer prescribed an inhaler? If yes, please explain any instructions.
Is there anything else you want PYC to know (e.g. learning style, identity, etc.)?
PAYMENT AND AGREEMENT
If you would like to request Tuition Assistance - please fill out this form.
To secure your singer's seat in camp, PYC requires payment in full or a $35 deposit at the time of registration.

Your $35 deposit will be deducted from your full camp tuition. The remaining balance must be paid by June 1, 2024.

$35 deposit option ends June 1, 2024.
Please select a payment option.*

Option A: Pay now in-full by credit cardOption B: Pay now in-full by check
Upon submission of this form, you will be directed to a payment page to complete your payment in full. If you have selected Option B above, you can ignore the redirection and mail your payment to:

PITTSBURGH YOUTH CHORUS

212 NINTH STREET, SUITE 601

PITTSBURGH, PA 15222

Check must be post marked within 5 days of registering.

If you chose Option A and are not automatically redirected, please email info@pittsburghyouthchorus.org for a payment link. You can also view the payment link in your registration confirmation email.
You selected to put down a $35 deposit, please select "Camp Deposit" so you can pay at the end of the form. *
prevnext( X )
Camp Deposit
$35.00

Total

$0.00
Duquesne University Waiver
Duquesne University (PYC's host site for rehearsals) Waiver

Music for Minors: Parental Consent, Emergency Contact, and Legal Release
This form must be completed prior to participating in musical events and activities hosted on Duquesne University's campus.

Fill out the waiver BEFORE SUBMITTING THIS FORM here.
I have filled out and submitted the Duquesne University Waiver*

YES
Informed Consent and Acknowledgement

1. Behavior that is destructive, dangerous, or threatening/harmful toward other participants may be grounds for removal from the camp without refund. Decisions regarding the response to any inappropriate behavior, including removal from the camp, will be handled on a case-by-case basis at the discretion of the Camp Director and the Executive Artistic Director, both of whom are training and certified educators.
2. I/We agree to indemnify and hold harmless Pittsburgh Youth Chorus, its directors, employees (full and part-time), members, and parent participants from any liability including personal injury (including death), property damage, costs, or expenses (including attorneys' fees) resulting from actions, other than willful misconduct or gross negligence, taken on behalf of my child or otherwise arising from my child's participation in PYC activities.
3. I/We hereby acknowledge and agree that in the event of an injury to us, we will apply our own medical, hospitalization and/or accident insurance toward the payment of any and all expenses incurred and will not look to Pittsburgh Youth Chorus for the payment of any medical or injury-related expenses.
4. I/We understand that failure to comply with these terms and conditions may result in exclusion from the program.
6. I/We understand that PYC captures photo and video content of its program for use in a variety of print and online publications. I understand that unless I provide written notification to PYC stating that I do not want my child to be photographed, that I am permitting PYC to use and publish photos and videos of my child, or those which he/she may be included as a part of a group for editorial news releases, advertising, and any other purpose and in any other manner and medium. I further understand that unless I notify PYC to the contrary, I release the photographer and his or her legal representatives and assigns from all claims and liability relating to said content capture.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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2024 Summer Singers Camp Registration

Duquesne University Waiver