E X T R A V A G A N...

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E X T R A V A G A N...
EXTRAVAGANZA - TN MIDSOUTH
Dates: November 14-16, 2014
Location: Hermitage COTN, 4151 Saundersville Rd. Old Hickory, TN 37138 (Friday & Saturday)
Trevecca Nazarene University, Boone Building (Sunday)
Cost: $50 (this covers event costs along with lunch and dinner on Saturday)
Deadline: Forms should be postmarked by October 17, 2014. Forms postmarked after that will incur a
$15 late fee. Walk Up Forms (after November 6, 2014) will incur a $25 late fee.
*Youth Leaders, please send ONE CHURCH CHECK with an itemized list of check coverage.
FLY CHURCH DEADLINE: completed and notarized forms must be turned in to Mike Redding by
Wednesday, October 15th.
Age levels for sports SHOULD be marked on registration form in accordance with regulations below.
Age guidelines are as follows:
a. Minimum age: Must be in 6th grade and at least 11 years of age by 9/1/14 to compete in 2015
[email protected]
b. Maximum age: Currently attending, and not graduated from, a high school prior to the
beginning of the school year in which they compete. Participants must not have reached their
20th birthday by the date of the regional event. (Seniors who finish course work in mid-year
remain eligible through the year.)
c. Age levels for talent:
Early Youth------------------------Grades 9 and below
Senior Youth----------------------Grades 10 and above
Age levels for individual sports:
Junior High ------------------------Ages 11-13
Middle High -----------------------Ages 14-15
Senior High ------------------------Ages 16-19
d. Team Sports: Ages 11-19 will be competing for spots on the TNT teams. However, we will be
providing some tournaments for middle school students at the district level to give the younger
students an opportunity to compete against students their own age. Middle school students
have an option to compete in middle or high school events.
(Ages are determined as of September 1, 2014 for this competition year.)
For Questions Contact:
Stephen Kihnley, Sports Director, 615.854.3295, [email protected]
Jamin Wentworth, Arts Director, 615.456.2903, [email protected]
Jennifer Henderson, Extravaganza/TNT Registrar 615.767.3127, [email protected]
TN MIDSOUTH NYI Registration Form
Extravaganza & TNT
District:
MIDSOUTH/TN
Church______________________________________________
Name:
_______________________________________________________________________________
Address:
_______________________________________________________________________________
(Street)
_______________________________________________________________________________
(city)
(state)
(zip code)
Phone: (____) _____________________
Date of Birth _______________
Age: _________
Grade in School: __________ Anticipated year of High School Graduation: ______
E-Mail Address:___________________________
Teen Cell Phone: _____________________
______ Teen Entrant ______ Teen Spectator (Check one)
Shirt Size S M L XL XXL (Circle one.)
TEEN ENTRANT INFORMATION
GENDER
___ Male
___ Female
AGE LEVEL ARTS
___ Early Youth (Grade 9 and below)
___ Senior Youth (Grade 10 and up)
AGE LEVEL INDIVIDUAL SPORTS
____ Junior High (Age 11-13) ____ Middle High (Age 14-15)
____ Senior High (Age 16-19)
_________________________________________________________________________________________
NOTE FOR TNT: Entrants can compete in no more than THREE categories, including a maximum of TWO tournament style (*)
events at TNT. Entrants who compete in Bible Quizzing may not compete in any other Tournament events. Display events (art,
creative writing, video production), exhibition events, and participation in vocal choir are not counted toward this limitation.
NOTE FOR EXTRAVAGANZA: Entrants can compete in multiple events, however keep in mind that due to the schedule and
location for different events, you may not be able to compete in all the categories you desire. We suggest choosing your best 3
categories.
ART
____ Oil/Acrylic
____ Water
____ Pencil
____ Pen/Ink
____ Chalk/Pastels
____ Still Photography
____ Mixed Media
____ 3-D Art
____ Graphic Design
CREATIVE MINISTRIES
____ Puppets
____ Video Production
____ Preaching
____ Dramatic Monologue
____ Dramatic Group
____ Human Video Solo
____ Human Video Group
____ Sign Language
____ Interpretive Worship Solo
____ Interpretive Worship Group
____ Worship Band
CREATIVE WRITING
____ Prose
____ Poetry
SPEECH
____ Oral Interpret.
____ Impromptu
____ Original Oratory
____ Contextual Storytelling
MATH & BUSINESS
____ Math
____ Accounting
VOCAL MUSIC
____ Vocal Solo
____ Vocal Duet
____ Vocal Small Group
____ Vocal Ensemble
____ Vocal Choir
____ Singer/Songwriter
INDIVIDUAL SPORTS
____ * Table Tennis
____ * Tennis
____ Skateboarding
____ Swimming
____ 5K Cross Country Run
____ Golf
____ 100 Meter Dash
TEAM SPORTS
____ * Co-Ed Softball
____ * Ladies Basketball
____ * Ladies Volleyball
____ * Ladies Soccer
____ * Men’s Beach Volleyball
____ * Men’s Soccer
____ * Men’s Flag Football
____ * Men’s Basketball
____ * Dodge Ball
____ *Ultimate Frisbee
____ *Ladies Flag Football
INSTRUMENTAL MUSIC
____ Brass Solo
____ Instrum. Group
____ Woodwinds Solo
____ Keyboard Solo
____ Strings Solo
____ Percussion Solo
__________________________________ is a member of the local NYI. ______________________________________
(Participant’s name)
(Pastor or Local NYI Pres. Signature)
EXTRAVAGANZA and TNT REGISTRATION FORM
THESE TNT EVENTS ARE SPONSORED BY THE MIDSOUTH DISTRICT NYI AND THE SOUTHEAST REGIONAL NYI IN COOPERATION WITH TNU.
Name of Participant: __________________________________________________________________________________________
INSURANCE AND MEDICAL INFORMATION
(All participants must be covered by their own personal insurance.)
Please list any medical problems: ________________________________________________________________________________
Allergies: ___________________________________________________________________________________________________
Past Surgeries: _______________________________________________________________________________________________
Name of medications & dosage you will be taking: __________________________________________________________________
List medications you are allergic to: ______________________________________________________________________________
Home Phone: (___) ____________________________________Work Phone: (____) ______________________________________
Emergency Phone: (____) _______________________________Contact Person: __________________________________________
Insurance Company ____________________________________Policy # ________________________________________________
TEEN: I have read the regional Conduct Guidelines and promise to live within these guidelines during TNT @ TNU. I also promise
to cooperate with District sponsors and be under their authority. I am aware that failure to do so will result in disciplinary action.
______________________________________
(Teen Signature)
PARENTS:
For purposes of this document, “TNT @ TNU” shall refer to the April 9-12, 2015 TNT event held at Trevecca as well as the
MidSouth District Tennessee Extravaganza event that precedes it at Hermitage Church of the Nazarene, November 14-16, 2014; and
any sports practices organized by MSNYI Coaches at any church or recreational facility located on the MidSouth District on any date
between November 16, 2014 and the TNT Event, April 9-12.
I hereby give authority to the Southeast Region NYI Leadership and the MidSouth District NYI leadership, to include Jason
Underwood, Stephen Kihnley, Jamin Wentworth, Jennifer Henderson, my son’s/daughter’s designated sporting event coach, or (stated
youth worker/pastor) __________________ to obtain necessary medical attention or to authorize treatment for my son/daughter at any
hospital in the event of a medical emergency.
I also recognize the authority of all adult sponsors, MSNYI Extravaganza staff, and the TNT @ TNU staff as those who will
supervise these events and uphold proper conduct. The first step of discipline, should such become necessary, will be a warning and
instruction. The second will be a telephone call to the parent or guardian concerning the participation of my son/daughter, _________.
I understand that the events of Extravaganza and TNT will require my son/daughter to make choices and to keep a schedule, and
that he/she may not be under direct adult supervision at all times.
I agree to release and hold harmless any and all staff and lay assistants of MSDistrict/Regional NYI or Trevecca Nazarene
University from any and all claims, suits, costs, and actions of any kind whatsoever, arising from their exercise of the power granted
by this authorization, unless due to intentional wrongdoing.
My son/daughter has my permission to attend Extravaganza and TNT @ TNU and any related practices.
NOTE: (Valuables should be left at home.)
Parent/Guardian Signature _____________________________________________________
(Signature must be in the presence of a Notary public)
Before me, A Notary Public, in and for said County and State/Province this ________ day of _______201___,
personally appeared ______________________________ and acknowledged execution of the foregoing. In Witness
Whereof, I have hereunto set my hand and Notary Seal.
State/Province of: _____________________________County of: ___________________________
Notary Public Signature: ________________________________
My Commission expiration date: ______/_____/______
Notary Seal