4-H Talent Show 2010 *Name: *Address: *City: State: Zip Code: *Home Phone: ( ) Cell phone: ( ) *Parent’s Names: E‐mail: *Number of family members attending: Talent Category: (please check one): Musical Instrument: Humorous or Dramatic Skit Dance Song: Name of Song: Age Category (please check one): Cloverbud (5‐8) Junior (9‐13) Senior (14‐19) Group Act (Group can consist of various ages) I acknowledge that I have read the entry rules attached and agree to abide by them. X ___/___/___ Signature of Contestant Date Completed forms should be mailed to: Surry County 4‐H Attn: Teresa Wilkins P.O. Box 324 Dobson, NC 27017 Deadline to turn in registration forms is Tuesday, January 19, 2010. *Required fields – must be filled out. RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT AND CONSENT TO MEDICAL TREATMENT Minor’s Form for 4‐H Youth Participation By our signatures below, we acknowledge that we are aware of, appreciate the character of, and voluntarily assume the risks involved in participating in 4‐H Talent Show 2010 By our signatures below, on behalf of ourselves, our heirs, next of kin, successors in interest, assigns, personal representatives, and agents, we hereby: 1. Waive any claim or cause of action against and release from liability the State of North Carolina, its officers, employees, and agents for any liability for injuries to person or property resulting from participation in the activity listed above; 2. Agree to indemnify and hold harmless the State of North Carolina , its officers, employees, and agents for any claims, causes of action, or liability to any other person arising from participation in the activity listed above; 3. Consent to receive any medical treatment deemed advisable during participation in the activity listed above; and 4. Acknowledge that we are signing below as a minor child and as the parent or legal guardian of the minor child named below. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT AND CONSENT TO MEDICAL TREATEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Minor’s Name: Date of Birth: Signature: Address: Date: Guardian’s Name: Date of Birth: Signature: Address: Date: Educator’s Signature: This copy to be kept on file in the County Extension Office North Carolina State University • College of Agriculture and Life Sciences • North Carolina Cooperative Extension Service 4‐H Talent Show Official Rules and Information 1. 4‐H Talent Show is open to all AMATEUR entertainers between the ages of 5 and 19. Professional (union musician or performers whole is a principle source of income) are not permitted to enter. 2. Entry forms need to be received no later than Tuesday, January 19, 2010. All entries received after this date will be returned. Act slots will be filled once entry form is received. 3. The time and date of the 4‐H Talent Show is 6:00 p.m., January 26, 2010, at the First United Methodist Church in Pilot Mountain, North Carolina. 4. All contestants can only participate in one show category in their age group. 5. Contestants who participate in the Group Category can be from various age groups. If there are any children under the age of nine in your group, that group will not be able to advance to district competition, but will still be eligible for Best in Show. 6. All contestants between the ages of 9 and 19 are eligible for district competition; however, judges will only select two acts to advance. 7. Vocalists may use TAPED MUSIC WITH NO VOCAL BACKUP. All contestants are required to use the sound system provided at the show. 8. All acts will have no more than 4 minutes to perform. The judges will maintain timings for all of the acts. Acts that violate this time limit will be disqualified. 9. In the event of a tie, the winner will be determined by the audience with a show of applause. 10. This is a family talent show. The judges and Talent Show organizer reserves the right to disqualify any act that does not display appropriate material. 11. If there is a lack of entries in any of the categories, the Talent Show organizer reserves the right to combine categories. 12. All decisions of the judges are final.
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