Storyteller’s Name
Parent/Guardian’s Name
Street Address
City
State
ZIP code
County
Home Telephone
Second Telephone
E-mail (enter “N/A” if no email address is available)
If this entry is being submitted by an organization/school, please complete the following additional contact information:
Name of Organization/School
Contact Person
Contact Person Phone Number
Second Telephone
E-mail (enter “N/A” if no email address is available)

Permissions

Check the following boxes to indicate compliance.

I hereby give my permission for my child/ward (type child’s full name in box, please) to compete in the Kentucky Division of National Youth Storytelling Showcase.

I hereby give permission for my child's photograph, bio, hometown, and state to appear on the Kentucky Storytelling Association (KSA) and City of Pigeon Forge website(s). Street addresses and phone numbers would not be publicly posted at any time. (City of Pigeon Forge, TN, hosts the National Youth Storytelling Showcase events.)

I understand that video tape/photographs/recordings made for and of this event may be viewed by anyone associated with the event and become the property of the Kentucky Storytelling Association (KSA) and/or the Pigeon Forge Office of Special Events.

I understand the event(s) may be taped (video or audio) and that the tape(s) maybe used for promotional purposes by the KSA and/or the City of Pigeon Forge.

Required – Signature of Storyteller and Parent/Guardian

Storyteller Signature ___________________________ Date ___________

Parent/Guardian Signature _______________________Date ___________

Mail or deliver this signed Entry & Permission Form and your DVD/VHS Entry to:

The Kentucky Storytelling Association is not responsible for lost, stolen, late delivered, or undelivered entries or entries that will not play on standard home video/DVD equipment.

Please check that the above information is correct.

NOTE: Please print two copies of this completed form using your web browser's print button (which usually looks like a printer) BEFORE YOU CLICK ON THE SUBMIT BUTTON BELOW. You will need a copy for your entry and a copy for your records.

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