Storyteller’s Name
Storyteller’s Date of Birth
Parent/Guardian’s Name
Street Address
City
State
ZIP code
County
Parent/Guardian Telephone
Parent/Guardian Second Telephone
Parent/Guardian E-mail (enter “N/A” if no email address is available)
What is the best way to reach the entrant’s parent/guardian?	Email Phone voice message Phone text message
If the entrant’s parent/guardian wishes to authorize a different adult to serve as the entrant’s contact, please provide the name and full contact information for that person. (Note: If a teacher, KSA will need to be able to reach them during the summer, and the teacher will also need to be able to reach the KYS entrant during the summer. Note: Anything sent by postal mail will always go to the entrant’s mailing address.)
Entry Method	Mailed DVD       Electronic Video Link If you are entering through a mailed DVD, your signed permission form and your DVD must be postmarked or hand delivered by midnight June 1st. If you are submitting via electronic video link, your signed permission form must be postmarked or hand delivered by Midnight June 1st. Please provide the link to your online video here TIP: Make sure your link works. Test it!
Teller’s hometown newspaper(s)
How did you learn about the Kentucky Youth Storytelling program?
Teller’s School (if applicable):
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)

Judging Accommodations

Please tell us anything we need to know in order to be able to judge your storytelling fairly. For example: Are you a teller who is deaf? Are you a teller who is blind? Are you a teller with limited mobility? Was your first language a language other than English? Are you a teller with a speech impediment? Other information we need to consider?

Story Information

We welcome all kinds of stories. Please tell us about the story you’ve chosen.

I wrote this story.

I heard this story. Who told it and what is your relationship to them?

This story is a tale I have retold based on several sources. List the sources.

This story was written by a particular author. List author, title, publisher, and date of publication.

I tell this story using the author’s exact words.

I have adapted/changed the author’s work for storytelling. Describe your adaptations/changes.

Other/additional information needed to help KSA understand the source of this story. Please explain.

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 Youth Storytelling.

I hereby give permission for my child's photograph, bio, hometown, and state to appear on the Kentucky Storytelling Association (KSA) website. Street addresses and phone numbers would not be publicly posted at any time.

I understand that excerpts from my child's video entry may be used to promote the Kentucky Storytelling Association and the Kentucky Youth Storytelling Program.

I understand that performances presented on behalf of KSA may be taped (video or audio) or photographed and that the recordings and photos may be used for promotional purposes by KSA.

Required – Signature of Storyteller and Parent/Guardian

Storyteller Signature ___________________________ Date ___________

Parent/Guardian Signature _______________________Date ___________

Mail this signed Entry & Permission Form 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 DVD or computer 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. In lieu of mailing an entry form, a scanned signed form may be sent via email.

Please enter the word nospam in the box provided below. This is a primitive spam prevention technique, and we apologize for the inconvenience.
nospam: