SilverArts
Official Entry Form
Sponsored by: Henderson County Parks and Recreation & Henderson County Arts Council
Name_____________________________________________________________ Age (as of 12/31/14)___________
(Please print)
Address_________________________________________________________________ Phone_________________
Post Office Box or Street
City
State
Zip
Date of Birth________________ Sex: Male____ Female____ Email_______________________________________
Please circle the Number of pieces or check which Performing Arts you wish to enter and return form with check
payable to: HCPRD (Henderson Co Parks & Rec Dept), 708 South Grove Street, Hendersonville, NC 28792
# of Visual Arts Pieces
# of Heritage/Folk Art Pieces
Performing Arts
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
___ Comedy/Drama
___ Dance
___ Vocal
___ Instrumental
___ Line Dancing
Number in group:____
Group title/name:
______________________
2
2
2
2
2
2
2
2
3 Acrylics
3 Drawing
3 Mixed Media
3 Oil
3 Pastels
3 Photography
3 Sculpture
3 Watercolor
# of Literary Arts Pieces
1 2 3 Essay
1 2 3 Life Experiences
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
Basket Weaving
China Painting
Crocheting
Rugs (hooked, braided, woven)
Jewelry
Knitting
Needlework
Pottery (thrown/hand built)
Quilting
Stained Glass
1 2 3 Tatting/Needlelace
1 2 3
1 2 3
(autobiographical)
1 2 3
1 2 3 Poetry
1 2 3
1 2 3 Short Story
1 2 3
Please give a brief description of your piece
Act length: 3 min time limit
Performance items needed:
___ Microphones #____
___ Chairs #____
___ Piano
___ Tape/CD Player
Tole/Decorative Painting
Weaving
Woodcarving
Woodworking
Items you will bring:
Woodturning
______________________________
__________________________________________________________
- Please pick up your SilverArts Guidelines 1. All items to be judged must be delivered to Henderson County Athletic and Activity Center from
3:00-5:00 p.m on April 30th. Judging will be from 9:30-11:00 a.m. on May 1st. Please do not remove
your art work until after 8:30 p.m. on May1st.
2. Artists may enter up to three pieces of art per Sub Category; categories are Literary, Heritage, and/or
Visual.
3. All entries must be the original work of the artist, completed within the last two years and created
after the artist turned 50 years of age.
4. Participants must provide their own display equipment if special needs are necessary.
5. An artist may not enter art work if the art piece, performance or literary work has qualified for a
SilverArts Showcase at State Finals in the past.
6. There are special guidelines for each category. Please read these guidelines and direct any questions or
comments to the SilverArts Coordinator, Karen Saine, 674-9784.
7. Each member of a performing arts group must fill out a SilverArts entry form.
Note: Henderson County Parks & Rec Dept reserves the right to change or alter dates and times due to unforeseen circumstances.
(over)
MEDICAL INFORMATION
(Required by North Carolina State Senior Games)
Do you have any medical problems? ____ Yes ____ No. If yes, please list any problems: ___________________________________
_____________________________________________________________________________________________________________
List any medications you are currently taking: ________________________________________________________________________
_____________________________________________________________________________________________________________
ALLERIGIC REACTIONS: Please list anything that you are allergic to, including medications: ________________________________
______________________________________________________________________________________________________________
Check all that apply:
Do you have a vision problem? ____Yes ____No
Do you wear glasses? ____ contacts? _____
Do you have a hearing problem?____Yes ____ No
Do you wear a hearing aid? ____ Yes ____ No
PHYSICAL LIMITATIONS:______________________________________________________________________________________
Physician’s name:______________________________________________ Physician’s phone:________________________________
WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the 2014 Four Seasons Senior Games program, which includes SilverArts, and
related events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. The risk of injury from the activities involved in this program is significant, including the potential for permanent
paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of
serious injury does exist; and,
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE
NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual significant
hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official
immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS
Four Seasons Senior Games, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, volunteers,
advertisers, and, if applicable, owners and lessors of premises used to conduct the event, WITH RESPECT TO ANY AND ALL INJURY,
DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE
RELEASEES OR OTHERWISE.
5. I understand that it is my responsibility to check with my local Sr Games Coordinator immediately following my local Sr Games to determine
if I qualified for State Finals and to get a State Finals Entry Packet. The State Finals Entry Form must be received in the NCSG office in
Raleigh by 5:00 pm on August 1st; early bird deadline is July 1st. I understand that this deadline is strictly enforced in fairness to all.
“To promote total health and physical fitness events of longer duration and lower intensity are strongly recommended.
High intensity types of activities are offered primarily for the conditioned, trained athlete.”
By entering Four Seasons Senior Games, I grant FSSG and its sponsors the right to use my name, quotes and any pictures taken of me during
Senior Games/SilverArts without remuneration.
I have read this Release of Liability and Assumption of Risk Agreement, fully understand its terms, understand that I have given up
substantial rights by signing it, and sign it freely and voluntarily without any inducement.
I have read this release
I have read this release
X__________________________________________ X _________________________________________ X____________________
Printed Name
Signature
Date
REGISTRATION FEES (Scholarships are available)
Registration Fee: $15.00, includes a free SilverArts tote bag
$15.00
Art Drop off April 30th 3:00-5:00 pm Athletics and Activity Center Gymnasium,
SilverArts Showcase and Celebration at AAC Gymnasium, May 1st 6:00- until 8:30 pm (details TBA)
*SPECIAL Dinner offered please indicate how many will be eating @ $8 each (pay caterer on-site 5-01)
Person to attend #________
* Catered Dinner begins at 5:15 p.m. from “Kids at Work Catering” and their instructors
Lemon Chicken
Rolls
Chiefs Salad
Tea
Rice Pilaf
Dessert
Viewers are encouraged to attend-no admission charge