Heart of a Champion Day is currently only offered to Atrium Health partner high schools. Students that aren't at one of the following schools in the dropdown, will not be able to attend.
Students are required to complete full registration with Parent or Guardian present.
*Please take the time, read through the questions, and answer to the best of your knowledge*
* = Required Information
This form is for the 2024-25 School Year
*
Have you ever participated in Heart of a Champion Day before?
Required
Yes
No
If Yes, what years?
Personal Emergency Contact Information
*
Student ID:
Required
*
School Attending Next Year:
'Select One'
Ardrey Kell
Ballantyne Ridge
Berry
Butler
Carmel Christian
Catawba Ridge School
Chambers
Charlotte Catholic
Charlotte Christian
East Lincoln
East Meck
Fort Mill
Garinger
Harding
Hickory Grove Christian
Hopewell
Hough
Independence
Lincoln Charter
Lincolnton
Mallard Creek
Mt. Island Charter
Myers Park
Nation Ford
North Lincoln
North Meck
Northwestern
Olympic
Palisades
Providence
Rock Hill
Rocky River
South Meck
South Pointe
West Charlotte
West Lincoln
West Meck
York HS
Required
*
Grade Entering:
'Select One'
9th
10th
11th
12th
Required
*
First Name:
Required
Middle Initial:
*
Last Name:
Required
*
Street Address:
Required
Apt/Unit:
*
City:
Required
*
State:
Required
*
Zip:
Required
*
Phone#:
Required
*
DOB:
DOB mm/dd/yyyy
*
Age:
Required
Race:
'Select One'
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Two or More Races (not Hispanic or Latino)
*
Gender assigned at birth:
'Select One'
Male
Female
Required
*
Email:
Required
Email will be used for further instructions
Parent/Guardian Information
*
Parent(s)/ Legal Guardian(s) Residing With:
Required
*
Who Has Custody:
Required
*
Fathers Name:
Required
*
Alternate Phone (Work/Cell):
Required
*
Mothers Name:
Required
*
Alternate Phone (Work/Cell):
Required
Family Physician/Pediatrician:
Physician Phone:
*
Preferred Hospital:
'Select One'
Atrium Health Cabarrus
Atrium Health Lincoln
Atrium Health Main
Atrium Health Mercy
Novant Health Presbyterian
Atrium Helath Pineville
Atrium Health Union
Atrium Health University
Novant Health Huntersville
Novant Health Matthews
Other
Required
*
Permission To Transport To Hospital:
'Select One'
Yes
No
Required
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