International Thespian Society
Dear ________________________________________
PLEASE READ THIS ENTIRE LETTER!! IT CONTAINS VITAL INFORMATION FOR
THE
STATE THESPIAN FESTIVAL!!
IF YOU WISH TO GO TO THIS TWO-DAY EVENT OF WORKSHOPS AND
COMPETITIONS, YOU MUST FOLLOW ALL DIRECTIONS AND MEET THE
APPLICATION DEADLINE: TUESDAY, NOVEMBER 8, 2016
Cost: $55.00 per member (includes t-shirt, insurance fees, workshops, and performance judging
fees). You may choose to pay for this partially with your current account money, and turn in
cash or check for the remainder. Remember that this will take money from your account for
your Broadway ticket. However, we will have another opportunity this year for fund raising
(Comedy Improv Nite). Note: You will also have to pack food or bring money to cover the
cost of two lunches and one dinner.
Note: Bring in any photos you have of the past year’s events (plays, events, etc.) of our actors and techies to
make up a display book for the festival. This book will be judged so that we can earn Honor Troupe
status. You may give these to me or directly to Perry Santos, our Historian, who will make up the book.
DATES OF FESTIVAL: SATURDAY, JANUARY 14 & SUNDAY, JANUARY 15, 2017
1. Have your parents complete and submit the attached student trip form permission slip. (Complete all
medical information—I bring this with me. I need the information in case of an emergency.)
Destination: Robbinsville HS, Robbinsville, NJ
Times: Jan. 14 – 6:30 a.m. to 9:30 p.m. and Jan. 15 – 7:30 a.m. to 7:00 p.m.
Chaperones: Mrs. Gargus & Ms. Patterson
2. Have your parents complete and sign the attached Student Form: 2017 Chapter Consent and Acceptance form.
3. Submit cash or check made out to Northern Burlington Thespians for your required fee. You
currently have $___________________________ in your name in our Thespian account. You must pay
at least $________________________ to go to the festival.
3. Read the rules to determine the performance areas you are interested in. Go to www.njthespians.org. Use the
dropdown, THESPIAN FESTIVAL to go to the desired category. You can also go to the judging materials
and check out the rubric used in each category.
4. Check and complete the categories on the attached sign-up sheet. (Read the directions!!!)
THESPIAN FESTIVAL SIGN-UP SHEET
TURN IN THIS SHEET WITH YOUR PERMISSION SLIP, CONSENT FORM, AND REQUIRED FEE
NAME_____________________________________ Amount paying: $______________ T-Shirt SIZE: ___________
You are allowed to enter FIVE categories. The five includes the Chapter Select play; however it does NOT include
the Senior Scholarship categories, Honor Troupe presenter, OR the Model for the Makeup Design category. We are allowed to
send as many entrants in each category as we wish, except Adv. Tech. Challenge: 1 team of 6, Tech. Olympics: 1 team of 5,
Improvisational Pairs: 3 pairs, Makeup Design: 2 pairs of artist and model, Trashy Costume: 1 pair, Senior Scholarship categories:
5 each
NOTE: If you sign up for something and do not perform it, you will be charged the $5.00 judging fee when we return
home.
_____Senior Scholarship Audition (seniors only—complete the downloadable application form)
_____Senior Scholarship Technical Design (seniors only—complete the downloadable application form)
_____Senior Scholarship Arts Advocacy (seniors only—complete the downloadable application form)
_____Contrasting Monologues
OR
_____Single Monologue (You may enter only ONE monologue category)
_____Duet Acting with ____________________________________ (No more separate categories of Drama or Comedy)
_____Improvisational Pair with ____________________________________________
_____Pantomime Pair with ____________________________________ OR _____Solo Pantomime (not both this year)
_____Solo Musical Theater
_____Duet Musical Theater with _______________________________
_____Group Musical Theatre (using 3 to 16 performers) List song title and musical it is taken from below and attach a list
with ALL of the names of at least 2 people to be in the performance with you.
_____New this year: Group Acting (using 3 to 16 performers) List play title that 5-minute scene is taken from below and
attach a list with ALL of the names of at least 2 people to be in the scene with you.
_________________________________________________________________________________________
_____Technical Olympics: You race against other schools doing backstage and technical tasks.
(We can only register one team of four members and one stage manager—5 people.)
_____Advanced Tech Challenge: You race against other schools doing very advanced backstage and technical tasks.
(We can only register one team of five members and one stage manager—6 people.)
_____ “Trashy Costume Competition”: I will design a costume made of trash using
________________________________________ as my model. (Only ONE pair slot for this event.)
_____Makeup Design: I will use __________________________________ as my model. (Only 3 slots.)
_____Costume Design
_____Set Design
_____Lighting Design
_____Theatre Marketing
_____Costume Construction
_____Stage Management
_____ Short Film—this film must be created and downloaded to YouTube and the YouTube link given to Mrs.
Gargus by Dec. 12. (It is judged BEFORE the festival.)
Student Form
2017 Chapter Consent and Acceptance form
Make 2 copies of the 2-page form for EVERY student attending the NJ Thespian Festival.
Completed forms MUST be turned in when your troupe arrives at registration. (Do no
mail them in advance.)
You must bring TWO copies of each form. One copy will be turned in at the Registration
pter Logo
Table. The other copy must be folded and inserted into the student’s name badge
holder in case of an immediate emergency.
The New Jersey Thespian Festival requires that this form be completed in full for each student delegate attending the New Jersey
Thespian Festival and signed by a parent or legal guardian. Type or print legibly. Enter Student’s name exactly as it appears on
registration form. Return by 1/14/2017.
LAST NAME
FIRST NAME
MIDDLE NAME
STREET ADDRESS (Home)
CITY
DATE OF BIRTH
GENDER
TELEPHONE (Home)
STATE
ZIP
SCHOOL
TROUPE NUMBER
NAME OF PARENT/GUARDIAN/NEXT OF KIN
RELATIONSHIP
PHONE NUMBER
NAME OF EMERGENCY CONTACT (1)
RELATIONSHIP
PHONE NUMBER
NAME OF EMERGENCY CONTACT (2)
RELATIONSHIP
PHONE NUMBER
NAME OF TROUPE DIRECTOR OR CHAPERONE ATTENDING EVENT
ALLERGIES TO FOOD AND/OR MEDICATIONS (IF NONE, please indicate)
MEDICATIONS CURRENTLY BEING TAKEN (IF NONE, please indicate)
PAST ILLNESSES OR INFORMATION NECESSARY IN AN EMERGENCY (IF NONE, please indicate)
FAMILY PHYSICIAN
HEALTH INSURANCE COMPANY
NAME
INSURANCE COMPANY NAME
PHYSICIAN PHONE NUMBER
POLICY HOLDER NAME
STREET ADDRESS
POLICY ID#
CITY, STATE, ZIP CODE
INSURANCE COMPANY STREET ADDRESS
CITY
GROUP/PLAN #
STATE
ZIP CODE
PRESCRIPTION INSURANCE
Rx GROUP #
PROVIDER NAME
PROVIDER PHONE NUMBER
Rx BIN #
ID #
I CONSENT TO MEDICAL TREATMENT
The undersigned hereby gives permission and consents to the New Jersey Thespian Festival and its Organizers to provide routine first aid, supervise the
self-administration of over-the-counter and prescription medications and to seek medical assistance and/or treatment on behalf of the Delegate in the
event that an illness or injury requiring such medical assistance and/or treatment occurs while the Delegate is attending or participating in the New
Jersey Thespian Festival. In the event that reasonable attempts to contact the individuals listed above are unsuccessful, the undersigned hereby
authorizes and consents to (1) the administration of any treatment deemed necessary by the physician listed below or, if unavailable, such other
licensed physician or other healthcare provider as may be available and (2) the transfer of the Delegate to the nearest hospital or other medical facility
for emergency medical evaluation, care and treatment. The indemnification in Section I below shall expressly cover any claims related to the actions by
the New Jersey Thespian Festival and its Organizers in (1) providing such routine first aid or supervision and (2) seeking such medical evaluation, care
and treatment, and in providing any information reasonably requested by such emergency medical providers for purposes of providing or billing for
services.
SIGNATURE OF PARENT/GUARDIAN
DATE
I. RELEASE & INDEMNIFICATION
The undersigned hereby releases and agrees to indemnify, save and hold harmless the New Jersey Thespian Festival, New Jersey Thespians, the
Educational Theatre Association, its programs, Chapter and other Group Affiliates, and all respective officers, employees, agents and
representatives of the aforementioned entities (each an “Organizer” and collectively the “Organizers”) from and against any and all claims,
demands, causes of actions, losses, liabilities, judgments, damages, costs and expenses (including reasonable attorneys’ fees) resulting from the
Delegate listed above participating in the New Jersey Thespian Festival. The undersigned shall give each Organizer prompt written notice of any
claim or facts or circumstances that might give rise to any claim for indemnification. The undersigned further agrees to be responsible for Delegate
while traveling to and from the New Jersey Thespian Festival including any expenses incurred by the Delegate, caused by the Delegate and/or any
personal injuries which may occur to the Delegate. The undersigned authorizes the Delegate to be released to the Troupe Director or Chaperone
listed on Page 1 of this form.
II. RULES AND REGULATIONS
The undersigned agrees that the Delegate shall abide by New Jersey Thespian Festival security rules and regulations. The undersigned understands
that, if the Delegate violates security rules and regulations, the Delegate may be returned home, and the undersigned (or parents and/or legal
guardians) may be financially responsible for all necessary costs incurred while sending Delegate home and no refunds will be granted.
III. PHOTO/VIDEO RELEASE
The undersigned irrevocably consents to being photographed or being recorded by means of video or audio tape recording by the Organizers, or a
designated representative of the Organizers. These photographs and/or recordings can be used, without compensation to undersigned and/or the
Delegate, in any public display, publication or media, or website, or in any manner or form, and at any time by the Organizers in promotion of the
mission to promote the theatrical arts and have theatre arts recognized in all phases of education. The undersigned releases the Organizers, and
their employees, agents, representatives, associates, Board of Director members, and consultants from any liability in connection with the use of
such photographic, video and/or audio materials.
IV. AUTHORIZATION
I consent to the use or disclosure of protected health information by the New Jersey Thespian Festival or its Organizers, or any third party health
care provider, for the purpose of analyzing, diagnosing, and providing treatment to the above stated Delegate, obtaining payment for health care
services rendered or to be rendered, or to conduct health care operations. A copy of this consent is as valid as the original. I authorize my insurance
benefits to be paid directly to the New Jersey Thespian Festival or its Organizers, or any third party health care provider. I assume full responsibility
for and agree to pay for all services rendered or to be rendered. I understand I have a right to receive a copy of this consent upon request, and to
revoke this consent in writing at any time except to the extent that the Organizers, or another third party health care provider, has taken action in
reliance on this consent. This authorization is valid one year from the date signed or through the term of coverage of the policy, and during the
required period to process the claims.
V. YOUTH ACTIVITY SAFETY POLICY
The New Jersey Thespian Festival has implemented a Youth Activity Safety Policy to provide a safe environment for youths participating in
activities, clinics, and conferences. This policy will help to protect participating youths from potential misconduct incidents and help provide a safe,
educational, and enjoyable activity/program experience.
The Delegate and the Delegate’s parent and/or legal guardian have read, understand and agree to be bound by the above provisions, as evidenced
by their signatures below:
SIGNATURE OF PARENT/GUARDIAN
DATE
SIGNATURE OF DELEGATE
DATE