Download ACT. FAST! One Day. One Play. Nine Hours.

SumnerPLAYSInformationandRegistrationPacket
ACT.FAST!
OneDay.OnePlay.NineHours.
SumnerCountyisblessedtohavestudentsrecognizedfortheirathleticandeducational
abilitiesonanannualbasis,butwearealsoblessedwithmanystudentswhohavedevelopeda
lovefortheperformingarts,however,tomuchlessfanfareandcelebration.
LastyeartheSUMNERPLAYSStudentTheatreChallengewascreatedtorecognizeand
celebratethetalentsofthesestudents.
In2016,almost60studentsfromacrossSumnerCountyparticipatedintheSUMNERPLAYS
StudentTheatreOne-ActChallenge,atVolState.another80participatedintheSUMNER
PLAYSStudentTheatreMusicalProductionChallengeheldinJanuary.Thesestudentsspent
thedayworkingwitheachother,mentoredbytheatreprofessionals,toproduceaone-actplay
ormusicalproductionwhichwasperformedforaliveaudiencelaterthatevening.
OnFebruary4,2017,theFOURTHSUMNERPLAYSMusicalTheatreProductionChallengewill
beheld(theFourthSUMNERPLAYSStudentTheatreOneActPlayChallengeiscurrently
scheduledforSeptember2017).Studentsparticipatinginthiseventwillbeimmersedina
completelyfabulous,completelyfundayofacting,rehearsingandperforming.Thiseventwill
beginat9:00amwithstudentsrandomlychosentobecomepartofateamthatwillbe
assignedamusicaltheatrenumberthattheywillbetaskedwithmemorizing,rehearsingand
performingduringthePerformanceShowcasebeginningat6:30pmthatsameevening.
Eachteamwillbeledbyamentor;anactor/actress,director,choreographerand/orcoachwith
professionaltheaterexperiencewhowillassisttheteamwithcasting,staging,andrehearsing
theirassignedpieceinpreparationfortheirliveperformance.
Act.Fast!AndjoinusonFebruary4,2017foranothergreatSUMNERPLAYSStudentTheatre
Challengeevent.
Who:
MiddleschoolandHighschool&VolStatestudentsresidinginSumnerandsurrounding
Counties(includingpublic,privateandhomeschoolstudents)
Where:
GodWhyChurch100GodWhyCt.Hendersonville,TN37075
When:
February4,2017:9:00am–8:00pm.TheStudentShowcaseperformanceswillbeginat
6:30p.m.andwillbeopentothepublic(freeentry)
RegistrationFee:
$20.00/student
WhatDoINeedtoBring?
Nothing.Justshowupreadytolearnandperform.
Lunchanddinnerwillbeprovided.
HowtoRegister:
ThankyouforyourinterestintheSumnerPLAYSStudentTheatreChallengebeingheldonSaturday,
February4th.Includedwiththispacketisacopyofthe:
1. RegistrationForm;
2. AccidentWaiver,ReleaseofLiability,MedicalConsentandPhotographyReleaseForm;anda
3. MedicalReleaseForm.
Pleasecompletetheseformsandsendacheckormoneyorderto:
Actor’sPointTheatreCompany
170DE.MainSt.#236
Hendersonville,TN37075
Ifpayingbycredit/debitcardeithercallActorsPointTheatreCompanyat(615)431-9620orlog-onto
actorspointtheatre.comandclickthe“SumnerPlays”link.
Welookforwardtoseeingyouonthe4thofFebruary.
RegistrationForm
StudentName:
Gender:
¡ Male
¡ Female
DateofBirth:
StreetAddress:
HomePhone:
CellPhone: Email:
School:___________________________________________________________________
Grade/Class:
¡Freshman
¡Sophomore
¡Junior
¡Senior
¡MiddleSchool
ActingExperience:
ParentsName:
Phone:
RelationshiptoStudent:
StudentSignature:
Date:
Parent/GuardianSignature: Date:
TheSumnerPlaysStudentTheatreChallengewillbeginat9:00AMonSaturday,February4,2017.
ParentsandguestsareinvitedtoattendtheStudentShowcaseat6:30PMthatevening.
Attendanceisfreebutdonationswillbeaccepted.
[email protected]
$20.00ParticipationFeePaidby:
ReceivedBy(PrintName):
¡ Cash
¡ Check
Date:
AccidentWaiver,ReleaseofLiability,MedicalConsent,PhotographyRelease
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING WITH ACTORS POINT THEATRE
COMPANY (hereafter APTC) AND God Why Church. ACTIVITIES OR EVENTS, including by way of example and not limitation, any
risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective
equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am
physically fit, have sufficiently prepared for participation with APTC, activities or events, and have not been advised to not participate by a
qualified medical professional. I certify that there are no health-related reasons or problems that preclude my participation with APTC/God
Why Church. I acknowledge that APTC/GOD WHY CHURCH, and sponsors, and organizers of any activity or event in which I may
participate will use this Accident Waiver and Release of Liability Form, and that it will govern my actions and responsibilities at said
company, its property, activity or event. In consideration of my application and permitting me to participate in this at this company,
activities or event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A)
I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or
fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind
which may hereafter occur to me including my traveling to and from the studio, activities and events, THE FOLLOWING ENTITIES OR
PERSONS: APTC/GOD WHY CHURCH, and/or their directors, officers, employees, volunteers, representatives, and agents, the activity
or event holders, activity or event sponsors, activity or event volunteers; (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT
TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation at this
company, activities or events, whether caused by the negligence of release or otherwise. I acknowledge that APTC/GOD WHY CHURCH,
and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of
any party or entity conducting a specific event or activity on behalf of APTC/ GOD WHY CHURCH. I acknowledge that this APTC/GOD
WHY CHURCH activity or event may involve a test of a person’s physical and mental limits and may carry with it the potential for death,
serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather,
condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers,
spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only
inherent to participants, but are also present for volunteers, and all associated with the participant at the activity.
I give permission for any and all medical attention to be administered to my child in the event of accident, injury, sickness, etc. I also
assume the responsibility for payment of such treatment. I understand that at this studio, events or related activities, I may be photographed.
I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by APTC/Carpe Artista, the event holders,
producers, sponsors, organizers, and assigns. I give full rights to APTC/ GOD WHY CHURCH and its staff to use photos, video images
and audio reproductions of me or my child to use for promotional or information purposes of APTC/ GOD WHY CHURCH or it’s agents.
Photos may appear with or without names in press releases, websites, and other advertising materials.
PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old)
The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her
child or ward’s participation with Actors Point/Carpe Artista/ Volunteer State Community College its activities or events, and has agreed
individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned
parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability,
loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act
and release said parties on behalf of the minor and the parents or legal guardian.
_______________________________
Participant’sName(Printed)
_______________________________
ParentorGuardian(Printed _____________________________
Participant’sSignature
_____________________________
Parent/GuardianSignature _______________ Date
Date
_______________
BY SIGNING ABOVE, I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE
THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
MedicalReleaseForm(Part1)
Parent/GuardianName:
StreetAddress:
HomePhone:
CellPhone:
Email:
Student’sName:
School:_____________________________
Listofknownmedicalconditions,includingFoodandDrugAllergies.Inaddition,please
includeanyandalloverthecounterandprescriptiondrugsstudentiscurrentlytaking.
InCaseofEmergency,pleasecontact:
Phone:
StreetAddress:
NameofPractice:
Phone:
StreetAddress:
NameofPractice:
Phone:
RelationshiptoStudent:
PrimaryPhysician’sName:
PrimaryDentist’sName:
MedicalReleaseForm(Part2)
PrimaryInsuranceCompany:
PolicyHolder’sName:
RelationshiptoChild:
ID#:
InsuranceCompanyPhone:
SecondaryInsuranceCompany:
PolicyHolder’sName:
RelationshiptoChild:
ID#:
InsuranceCompanyPhone:
StatementofConsent:
In the event of an emergency or non-emergency situation requiring medical treatment, I,
________________________________________, hereby grant permission for any and all medical
and/ordentalattentiontobeadministratedtomychild,intheeventofanaccidentinjuryorillness,until
suchtimeasIcanbecontacted.Thispermissionincludes,butisnotlimitedto,theadministrationof
first aid, the use of an ambulance and the administration of anesthesia and/or surgery, under the
recommendationofqualifiedmedicalpersonnel.
Parent/GuardianSignature: Date: