APPENDIX 7

SAN FERNANDO JUNIOR ARTS FESTIVAL 2017

MR & MISS NGC SANFEST TEEN TALENT COMPETITION
APPLICATION FORM
PLEASE COMPLETE IN BLOCK LETTERS:

FULL NAME: ______________________________________________________________________________________________

ADDRESS: _______________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

TEL NO.:__________________________B-MOBILE NO.:_________________________ DIGICEL NO.: ____________________

E-MAIL: __________________________________________________________________________________________________

DATE OF BIRTH: _______________________________________________ SEX: MALE FEMALE

SCHOOL: ________________________________________________________________________________________________

ADDRESS OF SCHOOL: ____________________________________________________________________________________

NAME OF PRINCIPAL: MR/MISS/MRS_________________________________________________________________________

TEL. NO:_____________________/_____________________/______________________FAX NO.:_________________________

EDUCATIONAL BACKGROUND
(Schools Attended)

1) ____________________________________________________________________________________________________

2) ____________________________________________________________________________________________________

ACHIEVEMENTS
1) _________________________________________________________________________________________________

2) _________________________________________________________________________________________________

3) _________________________________________________________________________________________________

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ORGANIZATIONS TO WHICH YOU BELONG & OTHER RELEVANT INFORMATION

1) _________________________________________________________________________________________________

2) _________________________________________________________________________________________________

3) _________________________________________________________________________________________________

HOBBIES & SPECIAL INTERESTS

______________________________________/ ___________________________________/ ______________________________

______________________________________/ ___________________________________/ ______________________________

I, the undersigned, do hereby consent and agree that the National Junior Arts Festival, its employees, or
agents have the right to take photographs, videotape, or digital recordings of me and to use these in any and
all media, now or hereafter known, and exclusively for the purpose of NGC San Fests Publicity and
Marketing. I further consent that my name and identity may be revealed therein or by descriptive text or
commentary.

DISCLAIMER: The San Fernando Arts Council and the National Gas Company are in no way responsible for
any injury, theft, loss or damage of whatever nature to body or property. Attendance and participation in the
Festival are deemed at our own risk and that everyone attending and/or participating must use good
judgement, obey all laws and take responsible care to avoid all injury to body and property.

NAME (BLOCK LETTERS) _____________________________ SIGNATURE_________________________

NAME OF PARENT: ________________________________________________________________________________________

CONTACT NOS.: ___________________________________/ _________________________________/ ____________________

____________________________________________ _______________________________________
Signature of Applicant Parents or Guardians Signature
(for applicants under the age of 18)

____________________________________________ _________________________________________
Signature of Principal (Please Affix School Stamp Here)

___________________________________________ __________________________________________
CHIEF COORDINATOR COORDINATOR

FOR OFFICAL USE ONLY

Application Fee: $50.00 Receipt No. __________________ Cash or Cheque

Photographs supplied: - Passport-sized photo 8x10 Portrait photo

REMARKS
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