2016 TASC Convention – Registration Checklist
March 4th-6th, Ravenwood High School
(Please complete and return this checklist with your registration information)
School:___________________________________________________________________________________
Note: For organizational purposes, Form Number is located in the lower right hand corner of each form
Please return the forms in numerical order
Please paperclip all forms together (NO STAPLES)
All forms must be mailed directly to Ravenwood, NO FAXES/SCANS PLEASE!
Thanks and we’re looking forward to your visit!
Please place a check mark next to the items below and return all items, including school check, to:
Ravenwood High School
1724 Wilson Pike
Brentwood, TN 37027
Attention: Stephanie Dykes
Form 1 – School Composite Registration Form
 All school information lines completed
 All housing/travel information completed
Questions? Contact:
stephanied@wcs.edu
Form 2 – Student Composite Registration Form
 All delegate names printed in alphabetical order
 Total fees multiplied and added together
Form 3 and 4 – Advisor/Principal Registration Form
 Number of Advisor Forms______ (One for each Advisor/Principal attending convention with ALL lines complete)
Form 5 – Student Registration Form
 Number of Student Forms______ (One form for each student attending convention with ALL lines complete)
 Medical Treatment Authorization and Liability Release signed by parent/guardian for EACH student
 Copy of FRONT and BACK of insurance card for EACH student attached to student reg. form
Forms 6, 7, and 8 – Dress Code Policy, Media Release Form, Delegate Responsibility, and
Delegate Release Form





Number of Completed Forms______ (One for each student attending convention with ALL lines completed/signed)
Dress Code Policy signed by delegate and parent
Media Release Form signed by delegate and parent
Delegate Responsibility form signed by delegate and parent
Delegate Release form signed by parent
Form 0
School Composite Registration Form
(Please PRINT neatly and complete EVERY line)
Note: Each school may register up to 15 student delegates and up to 4 advisors.
Schools running for office may register up to 20 student delegates. The Home
Stay option will be limited to 15 student delegates per school. After the February
3rd early deadline, additional registration spots may be available.
Email Stephanie Dykes at stephanied@wcs.edu to request
registration for additional delegates.
School Name:______________________________________________________________________________
School Level:
High School_____
Middle School_____
Junior High_____
School Colors:_________________________________________________ Mascot:_____________________
Attending Advisor Name(s): (Maximum of 4 advisors/principals)
1)___________________________________________ 2)___________________________________________
3)___________________________________________ 4)___________________________________________
State Area:
East_____
Middle_____
West_____
School Address:____________________________________________________________________________
City:_______________________________________________________ Zip:__________________________
School Phone: (______) _________________________
Will you use the home stay option for housing?
If yes, for how many students? _________
If no, where will you be lodging?
How will you be traveling?
Commuting_____
Yes_____
No_____
Hotel_______________
☐Car/Van- how many_____
Other (Specify:________)
☐Bus- how many_____
Form 1
Student Composite Registration Form
(Please PRINT neatly and complete EVERY line)
Please PRINT student names
Name
Gender Grade/Age T-Shirt Size
Home Stay
1 ______________________________________________ F M
____/____
_______
Y
N
2 ______________________________________________ F M
____/____
_______
Y
N
3 ______________________________________________ F M
____/____
_______
Y
N
4 ______________________________________________ F M
____/____
_______
Y
N
5 ______________________________________________ F M
____/____
_______
Y
N
6 ______________________________________________ F M
____/____
_______
Y
N
7 ______________________________________________ F M
____/____
_______
Y
N
8 ______________________________________________ F M
____/____
_______
Y
N
9 ______________________________________________ F M
____/____
_______
Y
N
10 ______________________________________________ F M
____/____
_______
Y
N
11 ______________________________________________ F M
____/____
_______
Y
N
12 ______________________________________________ F M
____/____
_______
Y
N
13 ______________________________________________ F M
____/____
_______
Y
N
14 ______________________________________________ F M
____/____
_______
Y
N
15 ______________________________________________ F M
____/____
_______
Y
N
No.
Total Fees
rd
____ Advisors multiplied by $135 each, if postmarked by February 3
__________
____ Students multiplied by $135 each, if postmarked by February 3d
__________
____ Advisors multiplied by $150 each, if postmarked by February 10th
__________
th
____ Students multiplied by $150 each, if postmarked by February 10
__________
Total Enclosed (payment must be enclosed):__________
Please make ALL checks payable to: Ravenwood High School
Remember:
Registration: $135/person Must be postmarked by February 3rd
Late Registration: $150/person Must be postmarked by February 10th
Form 2
Advisor Registration Form
(Copy as needed and complete one for EACH advisor attending, maximum 4.
Please PRINT neatly and complete EVERY line)
First Name _______________________________________ Last Name _____________________________
School ___________________________________________________________________________________
City ______________________________________________________ Zip __________________________
Home Phone (______) ________________________ Cell Phone (______) ___________________________
E-Mail (print neatly) ________________________________________________________Shirt Size _________
Number of years you have been an advisor at any school (total, including this year) __________________________
*Name of Emergency Contact _________________________________________________________________
*Emergency Phone Number __________________________________________________________________
List allergies, if any _________________________________________________________________________
Special/Health Concerns we need to know to make your stay more enjoyable.
_________________________________________________________________________
_________________________________________________________________________
Do you need vegetarian, vegan, or gluten free meals? If yes, which?
_______________________________
Hotel where advisor(s) will be staying:
Commuting _______ Hotel _____________________________ Other (specify): ____________________
I have read, understand, and agree to perform the Advisor’s responsibilities as listed on the “Advisor
Information” form.
_________________________________________________
Advisor’s Signature
______________
Date
Form 3
Advisor Information
TASC State Convention - 2016
Advisor Convention Responsibilities
 Chaperone students to, from, and during convention. (Remain on RHS campus during convention hours) (An adult
advisor from students’ school MUST accompany all students to the convention)



Advisors are responsible for the onsite registration of their group upon arrival at RHS.
Arrive on time to all General Sessions and meetings, making certain that students arrive on time and
attend all sessions as well. Sit in General Sessions with own delegation and supervise their students.
Monitor behavior of their students and correct inappropriate behavior. (No talking during presentations or
interfering with other’s ability to participate; keep students in positive behavior; no eating or drinking during
presentations/speakers)


Direct students to adhere to the convention dress code and instruct any student who chooses to break
dress code to change clothing. (See Form 6 for Dress Code guidelines)
Check to make sure students from their school are picked up by host family at each pick-up time.
For Schools staying in hotels, advisors are responsible for:
 Making hotel reservations prior to arrival. Check-in and checkout upon arrival at hotel.
 Having ALL students quiet and in their own rooms at stated curfew to stay for remainder of night.
 Insuring that students follow hotel rules and are courteous and respectful to other hotel guests.
 Insuring that NO STUDENTS OF THE OPPOSITE GENDER are permitted in the rooms of other
students, unless an advisor/chaperone is present in the room. (Violators will be asked to leave convention at own
expense)
Please make ALL checks payable to: Ravenwood High School
Remember:
Registration: $135/person Must be postmarked by February 3rd
Late Registration: $150/person Must be postmarked by February 10th
Questions? Contact:
stephanied@wcs.edu
Form 4
Student Registration Form
(Copy for each delegate. Please PRINT neatly and complete EVERY line)
First Name ____________________________________ Last Name _________________________________
Grade: ________
Gender:
F
M
Age _______
Shirt Size __________
What is your position on your student council? _________________________________________________
Home Address ____________________________________________________________________________
City ______________________________________________________ Zip ___________________________
Home Phone (_____)___________________________ Student Cell Phone (______)____________________
Parent/Guardian Name: __________________________ Parent Cell or Home
(______)_______________
Parent E-Mail (Print neatly) _________________________________________________________________________________
Do you have any special dietary needs? Vegetarian_____ Vegan_____ Gluten-Free_____ Other_________
*Parent/Guardian Names _______________________________________________________________
*Emergency Contact Other Than Parent __________________________________________________
*Emergency Contact Phone Number
Work
Cell Home (______)___________________________
*Insurance Company __________________________________________________________________
*Policy Number _______________________________________________________________________
***COPY OF FRONT AND BACK OF INSURANCE CARD MUST
Are you currently taking medication?
YES
BE ATTACHED***
NO
List Medication(s) ______________________________________________________________________
*List allergies, if any ____________________________________________________________________
*Special Housing/Health Concerns ________________________________________________________
______________________________________________________________________________________
MEDICAL TREATMENT AUTHORIZATION AND LIABILITY RELEASE
I, the understated parent or guardian, do hereby grant permission for my son/daughter to attend the
TASC convention March 4th-6th, 2016. In case my child sustains injury or illness during the time period of
the convention, I hereby authorize the Tennessee Association of Student Councils to obtain medical
treatment deemed necessary as prescribed by a licensed physician. I further acknowledge that I will be
responsible for any medical bills incurred on behalf of my son/daughter for the physical injury/illness that
he/she may sustain during the convention.
_________________________________
Parent/Guardian Signature
(______)___________________________ _______________
Phone Number
Date
Form 5
Student Dress Code Policy and Media Release Form
(Copy for each delegate. Please PRINT neatly and complete EVERY line)
Delegate Name: __________________________________________ School: ___________________________
(Please print neatly)
2016 TASC Convention – Dress Code Policy
The following dress code sets a tone of excellence, which is desirable for all TASC Leaders. It is expected
that all delegates attending the 2016 TASC Convention will adhere to the dress code. Delegates in violation
of this dress code will be asked to change.
Appropriate Dress:
*ALL shirts must have sleeves
*Shirts may not be low cut
*Pants and shirts must overlap in the middle
*Pants may not sag
*Skirts must be fingertip length or longer
*Shoes must be worn at all times
*Any person appearing on stage must wear dress attire: candidates, nominators, speech contestant
winners, executive board members, or any other person expecting to speak. Pants must be worn
when speaking on stage, no skirts or dresses (ties, suits, dress shirts, slacks).
Inappropriate dress items that are NOT to be worn:
*Spaghetti straps
*Strapless tops
*Low cut shirts
*Tank tops
*Crop tops
*No caps/hats of ANY type
*Cut or frayed clothing
*All shorts
*Clothing with inappropriate language (profanity, sexual references, alcohol, drugs, tobacco, etc.)
I/We have read the above dress code, understand what acceptable dress is, and agree to adhere to it.
Further, I/we understand that students in violation of dress code will be asked to change clothing.
_______________________________________
Signature of Student Delegate
_______________________________________
Signature of Parent/Guardian
2016 TASC Convention – Media Release
Please initial in front of statement below:
________ I understand that by permitting my child to attend the 2016 TASC Convention, I am giving
permission for him/her to be photographed, videotaped, or audio taped. Such items will be used only for the
purpose of promoting TASC as a youth organization though TASC newsletters, TASC brochures, TASC
websites, and print media. (TASC has a two-page Media Release and Notice of Understanding that is available upon
request from TASC Executive Director, Traci Spain. tspain@scsk12.org).
_______________________________________
Signature of Student Delegate
_______________________________________
Signature of Parent/Guardian
_______________________
Date
_______________________
Date
Form 6
Student Delegate Responsibilities Form
(Copy for each delegate. Please PRINT neatly and complete EVERY line)
Delegate Name: __________________________________________ School: ___________________________
(Please print neatly)
Convention rules are few because delegates are expected to behave in a mature and responsible manner
throughout the convention. Cooperation from all delegates ensures the success of the convention and provides
an example of excellent leadership.
Please read the following convention rules and sign on the lines below indicating that the rules have been read,
discussed, and understood by each delegate and his/her parent/guardian.
1. Delegates are to attend ALL convention activities. Delegates are to be attentive and respectful during
ALL convention activities/sessions.
2. The possession or use of alcoholic beverages, illegal drugs, weapons (play or real), or tobacco products
of any type is prohibited for the duration of the convention. Any delegate found in violation of this rule
will have parents notified and then sent home immediately at delegate’s expense.
3. Delegates are to respect the rights and safety of others. Delegates are also expected to demonstrate
respect toward other students, advisors, speakers, presenters, and guests.
4. Delegates are expected to respect the homes in which they are staying during host-family stays and are
to follow ALL rules set by host family. Delegates lodging at hotels are expected to abide by stated
curfews and rules for staying in the hotels. Any delegate found in violation of this rule will have
parents notified and then sent home immediately at delegate’s expense.
5. Delegates are expected to exhibit responsible behavior regarding health, safety, and welfare of others at
all times. Any delegate found in violation of this rule will have parents notified and then delegate will
be sent home immediately at delegate’s expense.
6. Delegates are to follow the enclosed dress code policy at all times. Each delegate must sign the Dress
Code Policy form. (See Form 6)
7. Convention identification name badges must be worn and visible to ALL convention activities.
We have read the above Convention Rules, understand the rules and consequences, and agree to them.
________________________________________
__________________________
Delegate Signature
Date
________________________________________
__________________________
Parent/Guardian Signature
Date
Form 7
2016 State Convention Delegate Release Form
(Copy for each delegate. Please PRINT neatly and complete EVERY line)
(Copy for each delegate. Please PRINT neatly and complete EVERY line)
First Name________________________________________
Last Name___________________________________________
School ___________________________________________
Circle: Grade: 6 7 8 9 10 11 12
Gender: F M
E-mail (PRINT neatly) _____________________________________________________
Parent signatures required below:
I, the parent/guardian of the above-named student give permission to his/her designated
school advisor/chaperone or to a school official from the workshop host school to seek
medical attention for my child in the case of an emergency. I agree to accept financial
responsibility for this medical treatment. I understand that a reasonable attempt will be made
to contact me before medical treatment is sought. I release TASC and school representatives
from any and all liability.
Please note any allergies, physical limitations, or special needs that your child might have:
Parent signature_____________________________________Date____________________
Parent daytime phone numbers_(_____)_________________(_____)__________________
Form 8