Japanese Speech Contest Entry Form

Name: ____________________________ _________________________ Grade: __________

English in Katakana

Home Address: ___________________________________________________________________

Telephone Number: _______________________ (The number we can reach you on the day of the speech contest.)

School Name: ________________________ Japanese Teacher’s Name: _____________________

Entry Category: Circle your entry category. #1 #2 #3 #4 #5

Free Speech Title __________________________ T-shirt size ____________

Division		Students’ levels
Division I	Poetry Recitation #1	High school Level 1 or II
Division II	Poetry Recitation #2	High school Level II or III
Division III	Free Speech	All level
Division IV	Free Speech	All level
Division V	Free Speech	College students and adults

Signatures:

I will participate in the Japanese Speech Contest.

________________________________________________ _______________________

Participant’s signature Date

I approve the student’s level.

________________________________________________ _______________________

Teacher’s signature Date

I give my son/daughter _____________________________ permission to participate in the Japanese Speech Contest to be held on February 14, 2009 at Ted Polk Middle School. I understand that the final contestants will be recorded in videotape. I hereby release his/her Japanese teacher, his/her school, Dallas Japanese Association and Japanese School of Dallas from any liabilities should any accidents occur during the contest.

________________________________________________ _______________________

Parent/Guardian signature (not necessary if you are over 18 years old.) Date

You must turn in this application by Friday, January 30, 2009. No exceptions will be made. Please print or type this form.