Registration Form – The Harrisburg Christian Performing Arts Center

Welcome to a production at Harrisburg Christian Performing Arts Center! There is a $235 (most productions) participation fee for each participant cast in the production. This nonrefundable participation fee must be paid online prior to attending the first rehearsal. The participation fee covers the cast member’s t-shirt, production support material, two (2) 4×6 character shots, an 8×10 full cast photo and a small portion of the expenses related to putting on the production (printing, costumes, props, set pieces, etc.). There are multi-family participation fee discounts for students in the same IRS filing household.

Registration temporarily unavailable. We apologize for this inconvenience.

General Information
Medical Information
Clearances
Fees
Payment

Twitter

GENERAL INFORMATION

CONTACT INFO OF PERSON FILLING OUT THIS FORM

First Name *

Last Name *

Email *

Phone Number *

Address *

Township/Borough *

City *

State *

Zip Code *

Employer *

Occupation *

Employer City *

Employer State *

Employer Zip Code *

Church Name *

Youth Pastor Name

Church Address, City, State *

ADDITIONAL PARENT/CONTACT INFO

Other Parent Name

Other Parent Phone

Other Parent Email

CAST/CREW MEMBERS

Select a Production *

List ALL cast and/or crew members that are part of your household. Include yourself if you are one of those cast or crew members.

How many members of your household are participating in this production? *

One Student

Two Students

Three Students

Four Students

Five Students

Volunteer Registration

Intern Registration

Participation Fee Calculation

Participation Fee: $ (with no fundraising)

Member 1 Legal Name *

Member 1 Cell (opt)

Member 1 Birthdate *

Member 1 Tshirt *

School Name (M1) *

School City/State (M1) *

Music Teacher Name (M1) *

Participant Medical Information

Primary Physician *

Physician Phone Number *

Health Insurance Carrier *

ID/Policy Number *

Group Number *

Food/environmental allergies

Allergies to medicine and what kind of reaction it causes

Medical, Psychiatric & Behavioral Diagnosis

Explain Conditions (e.g., how well controlled, what is being done to treat, what we would need to tell EMTs in an emergency)

Current medications and what they are prescribed for

Is there any other Information about the participant that we should know in seeking to best minister to his/her needs at HCPAC?

The health history and other information requested above are complete and accurate to the best of my knowledge. The participant herein described has permission to engage in all prescribed activities except as noted above I hereby grant authorization and consent for Harrisburg Christian Performing Arts Center (HCPAC) personnel to administer general first aid treatment for any minor injuries or illnesses experienced by myself/my minor child. If the injury or illness is life threatening or in need of emergency treatment and I am unable to authorize medical care, or, in the case of a minor, I, the parent/guardian cannot be reached, I grant authority to HCPAC personnel to seek medical attention on my behalf or that of my child listed above, to summon any and all professional emergency personnel to attend, transport, and treat myself/my minor child and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses resulting from such care.

Medical Info Accurate

I agree.*

Electronic Signature *

Child Clearances

Adult performers, age 18 years and over, must have the following forms on file to participate in rehearsals:

Act 34 – Criminal Record Check from the Pennsylvania State Police (FREE for volunteers)

Act 151 – Child Abuse History Clearances from the Department of Human Services (FREE for volunteers)

Act 114 – FBI Fingerprint Clearance (cost is $27.50) or Resident Disclosure Statement. Fingerprint Clearance is required if you have NOT been a continuous resident of PA for the last 10 years. If you have lived in PA for 10 consecutive years, you can submit the Resident Disclosure Statement

Contact HCPAC at [email protected] for help in filling out these requirements.

Participation Contract/Fees

There is a $235 participation fee for each participant cast in each production. $100 of this participation fee may be raised through cast fundraising. Fundraising must be completed by the final dress rehearsal. If the funds are not completely raised by this time, please bring a check or money order to the opening night performance to meet this obligation. Please choose the fundraising option at check out.

This nonrefundable participation fee must be paid online prior to attending the first rehearsal. The participation fee covers the performance t-shirt, production support material, two (2) 4×6 character shots, an 8×10 full cast photo and a small portion of the expenses related to putting on the production. There are multi-family participation fee discounts for individuals in the same IRS filing household.

Parents always perform for the reduced rate of $25 with (a) participating student performer(s) in a production that includes an adult cast.

Fee waivers and sponsorships are available for students that financially qualify. We consistently seek out sponsorship funds to ensure that ALL students are able to participate in our programming!

1 participant – $235 (for most productions)

2 participants – $435

3 participants – $585

4 participants – $710

5 participants – $823

Participation Fee Net

Total Cost: $

FUNDRAISING

I would like to reduce my registration fee by $100 per student and will commit to raising $100 per student in cast fundraising. I understand that if I have not raised the $100 per student by opening night of the show, I am required to pay the balance via check or money order.

Fundriasing Participation

Yes, I can’t wait to fundraise!!

No, I wll pay the full registration fee now.

PARTICIPATION FEE WAIVER

Any performer who would potentially be unable to participate in an activity as a result of this fee may request a needs-based fee waiver by submitting a Fee Waiver Application. This fee waiver will reduce the fee to $35.

Fee waiver consideration is given primarily to students. All fee waiver requests will be considered by a member of the Finance Committee and a decision will be provided within a week of the application being received.

Fee Waiver Application

Will you be submitting a Fee Waiver based on the criteria listed in the Fee Waiver Application?

fee waiver request

Yes, I plan on requesting a Fee Waiver.

No, I will not request a Fee Waiver.

PARTICIPATION CONTRACT

Please download and read the HCPAC Participation Contract before answering the questions below.

Download HCPAC Participation Contract

Contract Read

I agree.

I have read the Production Rehearsals, Policies and Promises of HCPAC and have reviewed them with all student members in my household. I/we promise our commitment to faithfully uphold the guidelines set forth. I/we acknowledge the failure of myself or my student members to follow through on any of these promises may jeopardize my/our involvement in this or subsequent productions.

Indemnify

I agree.

I shall indemnify and hold HCPAC harmless from any liability imposed upon HCPAC, adjudicated or otherwise, by virtue of any personal injury, illness or property damage arising from any use of the premises on the Harrisburg Christian Performing Arts Center by me, my agents and invitees, or by any acts done thereon by me, my agents and invitees, including court costs and counsel fees.

Media Release

I agree.

Media Release Authorization: I understand that by participating in the programming at Harrisburg Christian Performing Arts Center, I give Harrisburg Christian Performing Arts Center my permission to use a photograph or video of me/my child publicly to promote the Harrisburg Christian Performing Arts Center. I understand that the images may be used in print publications, online publications, presentations, websites, t-shirts and social media. I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

PAYMENT

Total

Total Due: $

First Name On Card *

Last Name On Card *

Address Line 1 *

Address Line 2

City *

Zip Code *

State/Province *

Country *

Card Number *

CVC/CVV *

Expiration Date *

Card Type *

Please click Submit only once. Form takes up to 30 seconds to process.

Username
Password

	Remember Me Lost your password? Register