2025 Program Registration Form

2025 Program 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 I 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*

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EDUCATION OF THE ARTS BY CATEGORIES:

Students may participate in ONLY ONE dance program and ONLY ONE music program (NO EXCEPTIONS) during the school year.
DANCE PROGRAM

FolkloricoFlamenco
MUSIC PROGRAM

TrumpetViolinGuitarronARMONIA _Guitar/VihuelaHarp
EXPERIENCE LEVEL*

BeginnerIntermediateAdvanced
Students may participate in ONLY ONE dance program and ONLY ONE music program (NO EXCEPTIONS) during the school year.
HCCM "A Company of Arts" PLEDGE

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

Enrollment is Limited

Due to space, MAXIMUM is 15 students per class & must have MINIMUM 4 students to make a class.

*All students must maintain a cumulative 75% or 2.75 Grade Point Average. Student will be asked to bring a copy of their report cards at the end of each 6 weeks.
Payment Schedule

Yearly Family Membership- $50.00 (Due at Registration)

Yearly dues for ballet/Mariachi programs per child- $360.00

(Due at registration or Quarterly charge)

Quarterly Charge per child-$90.00 (July, Oct, Jan, April)

NOTE: Must set up automatic payment plan with a credit card.

PURCHASE HERE - Must PAY Family membership plus 1st quarter minimum to register (Convenience fee added to payment)*

Family MembershipPER FAMILY due at registration annually! Multiple students in family pays only once.

$51.85 Quantity

Music/Mariachi ProgramYearly Payment

$372.50 Quantity

Dance Folklorico/Flamenco ProgramYearly Payment

$372.50 Quantity

Quarterly PaymentMusic/Dance program payment plan

$93.75 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, self-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
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2025 Program Registration Form

EDUCATION OF THE ARTS BY CATEGORIES:

Credit Card