Harmony eXplosion Northeast Registration Form

Harmony eXplosion Northeast Registration Form

Participant Information
Which event or events would you like to register for?*

HXN 2026 South Shore St. LambertHXNE 2026 Nova ScotiaHXNE 2026 New Brunswick
How will you participate? *
How will you participate ? *
This event's student enrollment deadline has passed.
Participant Date of Birth*
TODAY

MonthDayYear
Date
AGE
We notice that the participant is a minor. That's awesome, but it does mean that a parent or guardian must be present to read each page of this form and sign in each place where indicated.*

By checking here, I declare that I am a parent or guardian of the participant or that a parent or guardian is present to read and sign each page of this form.
Full Name of the Participant*

First NameMiddle InitialLast Name
Gender*

FemaleMaleOtherPrefer not to say
Preferred Pronouns
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Mobile Number
We may use this number to text updates.
Participant Email Address*
We will use this email to keep you informed.

Harmony eXplosion Northeast Registration Form

Parent or Guardian Information
Name of Parent or Guardian*

First NameLast Name
Email Address of Parent or Guardian *
example@example.com
Phone Number or Parent or Guardian*
Please enter a valid phone number.

Harmony eXplosion Northeast Registration Form

Participant Permission & Contract
The Harmony Explosion Camp Northeast experience should be educational, enjoyable and safe for all participants. Please read the following Rules & Regulations before completing and returning this form:
1. Participants are expected to arrive on time and to stay for the full duration of all scheduled activities, including meals, rehearsals, classes, workshop sessions and the concert.
2. Participants are to approach the camp and musical activities professionally; students should arrive prepared, bring all appropriate materials to rehearsals, and treat directors, clinicians, staff and peers with respect.
3. The use of alcohol, tobacco, illegal drugs or any other controlled substances is prohibited at all times. Participation in illegal activities will result in the notification of local law enforcement authorities. Engagement in any behavior risking injury to self or others is punishable by expulsion from camp.
4. Participants will respect the school’s facilities, as well as the property of the school and of other campers. Students should not engage in conduct which could damage facilities or property. Deliberate vandalism or theft will not be tolerated.
5. Participants will remain within the areas of campus designated for Harmony Explosion Camp use and may not leave campus without the direct supervision of a parent, staff member, or accompanying teacher.
6. Harmony Explosion Camp staff must be notified of any departures from the campus.
Harmony Explosion Camp is a public event where photography and videography will be used to record the day’s activities. These photos and videos may be published to the web and on social media for the purpose of promoting Harmony Explosion and other Youth in Harmony programs. By signing in the space below, I give permission to Harmony Explosion Northeast to use my likeness in these promotional images and videos.

I acknowledge that I may be invited to join online group conversations with students and camp administrators, teachers, and chaperones in advance of the event to gain additional information; to meet fellow singers; and after the event to provide feedback and to learn more about the musical style and future events. By signing in the space below, I give permission to Harmony Explosion Northeast to extend invitations to me through online communities and social media.

By signing in the space below, I acknowledge that I have read and that I understand and agree to abide by the rules and regulations set forth above. I understand that failure to comply with any of these rules may result in my parent(s)/guardian(s) being notified (for participants under 18 years of age), and my dismissal from the camp.
Participant Signature*

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By signing in the space below, I attest that I am the parent or guardian of the participant and that I give permission for the participant to attend the Harmony Explosion Northeast event. I understand the nature and purpose of the camp, and shall not hold the Harmony Explosion Northeast, its staff, its supporting organizations, or the hosting venue, institution or organization or its personnel responsible for any accident or incident that occurs, beyond the reasonable supervisory expectations which will prevail via adult chaperoning. I also authorize photographs of the participant to be taken and published on the web and on social media. I authorize Harmony Explosion Northeast staff to extend social media invitations to the participant to join online communities of fellow partiicpants. I understand that failure to abide by camp rules will result in dismissal of the participant from the camp, and that the participant must be picked up or sent home at my expense. I have read, understood and agree to the regulations set forth above.
Parent or Guardian Signature (for participants under the age of 18)

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Harmony eXplosion Northeast Registration Form

Health Information

Emergency Contacts*

	Name	Phone #	Relationship to Paritipcant
Contact #1
Contact #2
Contact #3

Does the participant have health insurance?*
Does the participant have a primary healthcare provider?*
Health Insurance Company*
Primary Healthcare Provider Name*
Policy Number*
Primary Healthcare Provider Phone *
Please enter a valid phone number.
Does the participant have allergies?*
Please list your allergies here.*
Please include any known allergies to medications, foods, chemicals, sting, etc.
Does the participant regularly take medication?*

Medical History
Please comment on any past or ongoing medical/surgical/psychiatric condition that the participant had/has that might be important for camp staff or emergency medical personnel to be aware of. (If none, please write “N/A”)
Permission for Treatment*

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By signing in the space above, you authorize the staff of Harmony Explosion Camp Northeast to obtain, provide, give consent, or furnish authorization for any necessary emergency medical services or treatment as soon as possible and after reasonable attempts have been made to contact you emergency contacts.
Parent or Guardian Permission for Treatment

Please complete one of the options below:
I, First Name* Last Name*, parent or guardian of the participant, in the event of an emergency Do Authorize Do NOT Authorize* the staff of Harmony Explosion Camp Northeast to obtain, provide, give consent, or furnish authorization for any necessary emergency medical services or treatment as soon as possible and after reasonable attempts have been made to contact me.
I have elected NOT to authorize HXNE staff to obtain, provide, give consent, or furnish authorization for any necessary emergency medical services or treatment. In the event of an emergency, I wish Harmony Explosion Camp Northeast staff to do the following instead:
Signature of Parent or Guardian*

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Harmony eXplosion Northeast Registration Form

Drug and Alcohol Agreement
In order to protect our campers and all staff personnel, the following protocol has been adopted regarding the Camp Drug and Alcohol Policy:

Any participant (e.g. Student, Peer Leader, Faculty Member, Staff Member, Chaperone, Music Educator or other Camp Personnel) found drinking or under the influence of alcoholic beverages, using or under the influence of drugs or illegal substances on camp grounds, including possession of any of the aforementioned or in violation of the Camp Drug and Alcohol Policy Statement, will be subject to the following:
- If the participant is under 18, immediate notification of the parents or legal guardians who will be required to pick-up or make arrangements for the pick-up and removal of the participant from HXNE.
- Immediate expulsion from the camp grounds.
- No refund of camp fees.
I agree to the above Drug and Alcohol Agreement:*

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Harmony eXplosion Northeast Registration Form

Chaperone, Peer Leader, Faculty & Staff Agreement of Expectations
As a chaperone, peer leader, faculty member, or staff member at HXNE, I agree that I will be fully participative in the camp by;
- Attending and fully participating in every aspect of the camp, to the best of my ability.
- Being sure that my students fully participate in the camp by attending all sessions and activities.
- Actively encouraging participants of the camp before, during, and after the camp.
- Being available to serve where needed throughout the camp.
- Working with camp staff to ensure safety and security for all students in attendance.
- Providing leadership, guidance, modeling to students throughout the camp.
- Allowing HX Camp to post photos and videos of yourself on the web and on social media.
By signing below you certify that you have read and understand the above expectations and agree to uphold them.
I agree to uphold the expectations for Chaperones, Peer Leaders, Faculty and Staff as described above:*

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As an adult chaperone, staff member or faulty member, by entering information below, I agree to allow HXNE to submit the following name and social secutiry information to an iCORI background check.
Complete legal name.*

First NameMiddle NameLast Name
Last 6 digits of your Social Security Number.*

Harmony eXplosion Northeast Registration Form

Additional Participant Information
What is your T-Shirt size?*
Options are adult sizes.
What is your voice part?*
What name or nickname would you like to appear on your event badge?
Please use the name that you would like people to address you by.
On the day of the event, what age will you be?*
How did you hear about HXNE?*
What type of school do you attend (as of the date of the event)?*
What is the name of the school that you attend (as of the date of the event)?
Which Barbershop organizations do you belong to? (check all that apply)

Barbershop Harmony SocietyHarmony IncorporatedSweet Adelines International
Which Barbershop organizations do your parents belong to? (check all that apply)

Barbershop Harmony SocietyHarmony IncorporatedSweet Adelines International
Do you have mobility challenges? If so, please describe here.
Do you have a preferred roommate for your overnight stay? If so, please list their name here.
Learning Materials

One of the ways we support our singers learning process is by distributing learning materials well in advance of the event. The materials include sheet music and recordings of each individual voice part. These materials are copyright protected and so must be shared by a secure means. We have chosen to share these with you in a Google Drive shared folder.
What email address can we share learning tracks to via Google Drive?*
This email address musts already be associated with a Google account. If it is not, you will need to create a google account to view the learning materials. iCloud addresses are not compatible. Some yahoo accounts and most school accounts addresses block sharing. Gmail addresses are preferred.

Optional Donation Opportunity
Dear parents of our students,

Did you know that HXNE events are in large part funded by generous donations from our community? HXNE hosts many one day camps throughout the year at little or no cost to students. All of the costs of our multi-day events are covered by donation with the excpetion of room and board.

The average cost per student to run this one-day camp is approximately $200 plus accommodations and food. This funding provides each of our students with world class faculty, staff and music clinicians who are internationally recognized as outstanding music educators, directors and performers.

This year’s camp will be funded in part by the generosity of local members of the Barbershop Harmony Society, Harmony Incorporated, and Sweet Adelines International who are all enthusiasts of this type of 4-part, close harmony singing. The camp is also supported by local chapters of all three organizations, fans and many quartets.

The Northeastern District of the Barbershop Harmony Society is dedicated to the cause of music education for youth in our communities and to creating opportunities for young people to find music in their lives that will last a lifetime. If you would like to contribute to this year’s Harmony Explosion Camp Northeast, please consider donating by check payable to ‘Northeastern District’ or donate online. You may send a check with your student’s forms to the address below or donate online at https://hxne.org/#donate

Harmony Explosion Camp Northeast
Roger Menard, HXNE 2025 Director
32 Snowshoe Trail, Hopkinton, NH 03229, USA

Thank you for considering a donation and we can’t wait to hear your high schooler singing at Harmony Explosion Camp this year!

In Harmony,

Roger Menard
Director of Harmony Explosion Northeast
BHS Northeastern District President
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Harmony eXplosion Northeast Registration Form

Harmony eXplosion Northeast Registration Form

Harmony eXplosion Northeast Registration Form

Harmony eXplosion Northeast Registration Form

Parent or Guardian Permission for Treatment

Harmony eXplosion Northeast Registration Form

Harmony eXplosion Northeast Registration Form

Harmony eXplosion Northeast Registration Form

Optional Donation Opportunity