Wipe Out Cancer Event (Talent Show to Support Cancer Patients)

We are so excited to have you participate and showcase your abilities in the 1st Oncotelligent's YOU'VE GOT TALENT! competition. Please fill out this application and submit to our Oncotelligent website by March 20th to ensure participation in the event on April 7th, 2018. There is an application fee of $25 -this includes a t-shirt, certificate, 1 guest entry ticket*, and raffle tickets.

*Entry ticket price is $4. Tickets can be bought in advance on our website, oncotelligent.org.

Participant's full Name (required)

Age (required)

Sex (required)
MaleFemaleOther

Grade (required)

Subject

Country/State (required)

Your Email (required)

Talent (required)
DanceVoiceOther

Level (required)
ElementaryIntermediateMiddleHighHomeschool

School List (required)
ArrowheadBloomingtonCOral CanyanCoral CliffCrimson ViewDiamond ValleyDixie SunEnterpriseHeritageHorizonHurricaneLaVerkin ELegacyLittle ValleyMajestic FieldsPanoramaRed MountainRiversideSandstoneSanta ClaraSpringdaleSunsetThree FallsFossile RidgeHurricaneLava RidgeSunrise RidgeTonaquintWater CanyonDesert HillsDixiePine ViewSnow CanyonMill CreekOther

What is your talent? Tell us what you will be performing.(required)

About me: Tell us about yourself! This will be featured in our program and handed out during the event to audience members. If you do not want your child to be featured in the event brochure, please write "I do not wish for my child to be featured in the YOU'VE GOT TALENT! event program."

Picture (max-2MB): If you’d like your child’s photo to be featured in the program, please upload a photo here. If you do not wish to have your child’s photo be featured in the program, leave empty.

Other details

Information: This event will be held all day at the Cox Performing Arts Center on the Dixie State University campus. Please select your time frame preference of when your child will perform. We will have tents and tables set up outside the building during the event for guest entertainment and local involvement. Guests are invited to come and go as they please once they have ticket stub and stamp to verify event re-entry.

Preferred Time Slot:
10am-12pm
12pm -2pm
2pm – 4pm
4pm – 6pm
No preference

Application fee: $25

LIABILITY RELEASE FORM
By signing this form, I agree and consent to the following:
I hereby acknowledge receipt and agreement with the following terms as a condition of my participation in the You’ve Got Talent! contest presented by Oncotelligent, to be held at the Cox Performing Arts Center on April 7th, 2018.

I understand and agree that during the event participation, I will be filmed ( with still or video cameras) and these pictures or videos will be appropriately utilized by Oncotelligent for the current of future purposes without any limitations.

I am advised that I should consult with my personal physician before undertaking the workshop or any exercise program. I have no physical or medical condition which to my knowledge would endanger myself or others if I participate in the event.

I understand that participating in this event may require mental judgment and a high degree of physical fitness, agility, stamina, and strength and that this may include strenuous exercise. I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which I may incur as a result of participating in this event.

I, individually, and on behalf of my heirs, successors, assigns and personal representatives, hereby agree to discharge, release, and hold harmless the Cox Performing Arts Center- DSU and Oncotelligent, their respective board members, trustees, officers, employees, agents and independent contractors, affiliates and the United States of America, from any and all liability whatsoever for any and all damages, losses, injuries (including death) I sustain to my person or property or both, including but not limited to any claims, demands, actions, causes of action, judgments, expenses, and costs, including attorney fees, which arise out of, result from, occurring during, or are connected in any manner with my participation in the event.
I agree that Oncotelligent and affiliates in any circumstance will not be responsible for any claims or liability.

If the participant is under 18, this form must be signed by a parent/guardian.

Participant/Parents Signature (write full name):(required)

Agree to terms and conditions? (required)
Yes