Young Adult Swing Dance Association Application for Dance Team Sponsorship I. Name of Male Dancer DOB Address Phone Number email Parents Name(s) Phone Parent(s) Address Parent(s) email Emergency Contact Name Emergency Contact Phone II. Name of Female Dancer DOB Address Phone Number email Parents Name(s) Phone Parent(s) Address Parent(s) email Emergency Contact Name Emergency Contact Phone Tour Events 2017 Capital (February), Easter Swing, (April), Swing Diego (May), Grand Nationals (May), Liberty (June), Phoenix 4 th of July Summer Camp (July), New Orleans Dance Mardi Gras (July), Tampa Bay Classic (August), Summer Hummer (August), Meet Me in Saint Louis (September), Boogie by the Bay (Oct.), DCSX (November), US Open (November) Events you wish to attend (Please list in order of priority) Have you attended prior? 1. Y N 2. Y N 3. Y N 4. Y N 5. Y N 6. Y N 7. Y N 8. Y N 9. Y N 10. Y N Page 1 of 6
III. Please list all events/competitions you have attended in the past 2 years Please list three references within the dance world (coaches, friends, etc), length of time you have known them and phone numbers *Please use a separate paper to submit a one page essay explaining why you feel you are deserving of this scholarship. Explain how you first became involved in the dance and how it has affected your life. IV. We understand that a YASDA sponsorship, if awarded, is intended to defray some of our travel, costume, and dance coaching expenses and that if we are awarded sponsorship funds, we will be expected to compete in the Young Adult/Junior Division at the event for which such funds have been awarded (the Sponsored Event ). Should we fail to timely register and compete in the Sponsored Event, we understand that our sponsorship may be revoked and no monies given to us. As a condition to being sponsored by YASDA, we agree that we will conduct ourselves in accordance with the YASDA Code of Conduct Agreement that follows this Application (which is hereby incorporated into and made a part of the Application) at all times while traveling to, attending, or returning home from any Sponsored Event. If attendance at a Sponsored Event requires an overnight stay for one or more nights, we will conduct ourselves in accordance with the Code of Conduct for the entire time of our participation, beginning when we depart our homes and ending when we return to our homes, regardless of whether we travel in a private vehicle or use public transportation and whether we stay in a hotel or other commercial overnight accommodation or in a private residence. We agree that no sponsorship money will be given to us until each of us and our Parent(s)/Guardian(s) have read, signed and returned a copy of the signed Code of Conduct Agreement to YASDA. We understand that failure of either or both of us to conduct ourselves in accordance with the YASDA Code of Conduct while traveling to, attending, or returning home from a Sponsored Event may, at YASDA s sole discretion, result in (i) our being required to return sponsorship funds to YASDA, (ii) our being deemed ineligible for future scholarships and/or (iii) any scholarships that have been awarded for future events may be revoked at the sole discretion of YASDA. We understand that Parent(s)/Guardian(s) are responsible for arranging for our safe travel, appropriate lodging and meals for a Sponsored Event. In addition, the Parent(s)/Guardian(s) of each of us who is under the age of eighteen (18) years on the date of a Sponsored Event must provide YASDA with the name, telephone number and address of the chaperon who will accompany us to such Sponsored Event on the Chaperon Form attached hereto. The Page 2 of 6
Chaperon Form must be signed by our Parent(s)/Guardian(s) and the chaperon(s). We understand and agree that no sponsorship funds will be released to us until YASDA has been provided with the signed Chaperon Form. We understand that failure to provide the Chaperon Form within seven (7) days of a Sponsored Event may result in our sponsorship being revoked and possibly no future sponsorships being awarded to us. In submitting this Application, we understand that YASDA has the right to reject our Application for any reason at any time. Submitting this Application confers no rights on us and the acceptance of the Application is always subject to rejection. We understand that the granting of a sponsorship to one or more Sponsored Event does not guarantee the award of a sponsorship to any other event. We understand that YASDA has no liability or responsibility to us based upon the Application. Furthermore, for valuable consideration received, each of us hereby (i) releases YASDA, its officers, directors, employees, agents, servants and volunteers from any and all liability and claims which may arise from the Application or from the awarding or not awarding of any sponsorship monies to us, or including any and all claims arising out of personal injuries or damages from any cause whatsoever and (ii) indemnifies YASDA, its officers, directors, employees, agents, servants and volunteers for any and all costs associated with any such claims. Junior Male Date Junior Female Date I hereby give permission for my child to participate in the swing dance competition or event for which he or she is seeking sponsorship (the Sponsored Event ). By signing the Sponsorship Application, I certify that my child is healthy and free of any physical, mental or emotional conditions that could cause any problems for him/her or other participants. In consideration of YASDA sponsoring my child, I hereby agree to be bound by all of the terms set forth herein, including, but not limited to, Section IV. Junior Male Parent/Guardian (if Junior Male is under 18 on date of signing) Date Date Junior Female Parent/Guardian (if Junior Female is under 18 on date of signing) Please send a copy of this application to yasdatour@gmail.com or Fax to 703-698-1216. You can reach Jim Coakley at 703-573-0959 9:00 AM 5:00 PM EST Page 3 of 6
CODE OF CONDUCT The Young Adult Swing Dance Association ( YASDA ) places a strong emphasis on character and integrity of our sponsorship recipients and expects each Sponsored Dancer to serve as a role model for other juniors (on and off the dance floor) and to conduct himself/ herself according to this YASDA Code of Conduct. The code operates in conjunction with the guidelines and regulations of the specific Sponsored Events. As the Sponsored Dancer and the Parent of a Sponsored Dancer, you are required to read, date and sign this document. This code of conduct agreement was developed to insure that you understand the rules, policies and expectations that you must abide by as well as acknowledge your awareness of the expectations placed upon you by YASDA as a condition to our sponsorship. You and your parents should review this contract in detail together This contract must be signed and dated by both parties to be valid. The undersigned Sponsored Dancer participating in (Sponsored Event) agrees to abide by the standards of conduct outlined below in addition to those established by the event organizers. You understand that for purposes of this Code of Conduct, the term at a Sponsored Event shall cover the entire time period beginning when you depart your home to travel to the event and ending when you return to your home after the event has concluded. 1. Sponsored Dancers are expected to be mature enough to govern their own behavior and are expected to behave in an exemplary manner. The reputation of YASDA, as well as other junior dancers, is dependent on your behavior. 2. First impressions are very important to your personal image, to YASDA and to the art of swing dancing. Appropriate attire is required the entire time you are at a Sponsored Event 3. The consumption of alcohol, the use of tobacco, or of non-prescription drugs or illegal substance of any kind will not be tolerated at any time. In addition, if you are found or suspected to be in the presence of others partaking in any of these activities at a private hotel party or at a hotel bar, at any time, you will be subject to the same punishments as if you had consumed such prohibited substances yourself. Selling, giving, delivering or possessing drugs, alcohol or tobacco products at any time is expressly prohibited. You are allowed to be at a hotel bar if in the presence of your parent or guardian to eat food. 4. You are expected to show respect to the event staff, other participants and your chaperon while at a Sponsored Event. Page 4 of 6
5. Violence and threat of violence will not be tolerated at any time. Bullying, threatening or menacing behavior is unacceptable. You may not possess a weapon or dangerous instrument to be used as a weapon at a Sponsored Event. 6. Inappropriate or disruptive behavior at a Sponsored Event is not permitted. This includes, but is not limited to: graffiti, littering, spitting, or throwing objects that could intentionally or unintentionally harm another or cause disorder. 7. Any damage or thievery incurred by a hotel or facility in which a Sponsored Event takes place directly or indirectly caused by you will be your responsibility. 8. Sponsored Events are scheduled for junior dancers to compete and interact with other young adult dancers and to explore dance as a means of creative expression. The events are not intended as a vacation spot for meeting someone you are dating and you should not seek out romantic relationships or engage in sexual activities while at a Sponsored Event. 9. If you do not adhere to the above rules, you may have your sponsorship revoked, be required to refund sponsorship monies awarded to you and/or be barred from receiving future sponsorships. If this happens, any Sponsorship Application submitted by a dancer who intends to dance with you at a Sponsored Event, will also be rejected. Signature of Sponsored Dancer Date Sponsored Dancer (Print Name) Signature of Parent/Guardian Date Parent/Guardian (Print Name) Page 5 of 6
CHAPERON FORM I, (Parent/Guardian), resident of (city), (state), parent and legal guardian of (the "Minor") do hereby authorize, of (city), (state) (the Chaperon ) to accompany the Minor to on the following date(s):, and if necessary, to order whatever medical treatment or emergency care for the Minor that the doctor administering the necessary treatment deems appropriate and to incur whatever expenses are necessary in light of such care in the event that I am unable to do so myself. In furtherance of this authorization, the Chaperon shall have full authority to sign any papers required and to give oral directions on my behalf. Any person or entity relying on the decision of the Chaperon shall not, as far as permitted by law, be held liable for relying on this authorization, except for gross negligence or willful misconduct. I intend for the Chaperon to be treated as I would be with respect to my rights regarding the use and disclosure of the Minor s individually identifiable health information or other medical records. This release authority applies to any and all information governed by the Health Insurance Portability and Accountability Act of 1996, 42 USC 1320d and 45 CFR 160-164. The authority given to the Chaperon herein shall expire on, 20. Date: Signature Parent/Guardian Print Name Parent/Guardian I, (Chaperon), hereby agree (i) to accompany the Minor to on the following date(s):, (ii) that I will supervise the Minor and (iii) be responsible for the Minor s health, welfare, safety and behavior while the Minor is in my care. I am at least 18 years of age and of the legal age to be a guardian per the laws of the Minor s home state and the state where the event is being held. Date: Address: Phone: Signature Chaperon Print Name Chaperon Page 6 of 6