{"id":4212,"date":"2024-03-28T19:12:04","date_gmt":"2024-03-28T19:12:04","guid":{"rendered":"https:\/\/www.akkaonline.org\/2016\/?page_id=4212"},"modified":"2024-03-28T19:12:05","modified_gmt":"2024-03-28T19:12:05","slug":"application-form-2","status":"publish","type":"page","link":"https:\/\/akkaonline.org\/2016\/application-form-2\/","title":{"rendered":"Application Form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1205-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1205\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/2016\/wp-json\/wp\/v2\/pages\/4212#wpcf7-f1205-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1205\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.2\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1205-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<font color=\"red\"><b>*<\/b><\/font> Indicates mandatory fields<br \/><br \/>\n\n<p><b>Are you\/your participants registered for the AKKA 2016 WKC?<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group wpcf7-form-control wpcf7-radio participant-reg\"><div class=\"radio\"><label><input name=\"participant-reg\" type=\"radio\" value=\"Yes\" aria-invalid=\"false\" aria-required=\"true\" required>Yes<\/label><\/div><div class=\"radio\"><label><input name=\"participant-reg\" type=\"radio\" value=\"No\" aria-invalid=\"false\" aria-required=\"true\" required>No<\/label><\/div><\/div>\n\n<p><b>Program Title:<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group program-title\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"program-title\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Program Type:<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group program-type\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required form-control\" name=\"program-type\" aria-invalid=\"false\" aria-required=\"true\" required><option value=\"Choose\">Choose<\/option><option value=\"Song(solo)\">Song(solo)<\/option><option value=\"Song(group)\">Song(group)<\/option><option value=\"Dance(solo)\">Dance(solo)<\/option><option value=\"Dance(group)\">Dance(group)<\/option><option value=\"Drama\">Drama<\/option><option value=\"Standup Comedy\">Standup Comedy<\/option><option value=\"Instrumentals\">Instrumentals<\/option><option value=\"Other\">Other<\/option><\/select><\/div>\n    <div class=\"form-group program-typeother\"><input class=\"wpcf7-form-control wpcf7-text form-control\" name=\"program-typeother\" type=\"text\" value=\"\" placeholder=\"If it is other, please enter the type here\" aria-invalid=\"false\"><\/div>\n\n<p><b>Program Description (not more than 120 words):<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group program-desc\"><textarea class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" name=\"program-desc\" rows=\"4\" aria-invalid=\"false\" aria-required=\"true\" required><\/textarea><\/div>\n\n<p><b>Program Duration (in minutes):<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n   Please refer to the program submission rules for duration requirements @ <a href=\"https:\/\/akkaonline.org\/2016\/programs\/participation-rules\/\" target=\"new\">https:\/\/akkaonline.org\/2016\/programs\/participation-rules\/<\/a> <br \/>\n    <div class=\"form-group program-duration\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"program-duration\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Number of Participants (only numeric up 99 can be accepted):<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group numberof-participants\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"numberof-participants\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Participant Name (if it is solo performance):<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group participant-name\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"participant-name\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Group Performance Names (if it is group performance document all participants names here separate by semicolon):<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group group-performancenames\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"group-performancenames\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Are participants taking part in additional programs:<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group wpcf7-form-control wpcf7-radio participants-additionalprog\"><div class=\"radio\"><label><input name=\"participants-additionalprog\" type=\"radio\" value=\"Yes\" aria-invalid=\"false\" aria-required=\"true\" required>Yes<\/label><\/div><div class=\"radio\"><label><input name=\"participants-additionalprog\" type=\"radio\" value=\"No\" aria-invalid=\"false\" aria-required=\"true\" required>No<\/label><\/div><\/div>\n\n<p><b>Participant Phone:<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group participant-phone\"><input class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel form-control\" name=\"participant-phone\" type=\"tel\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Participant Email:<\/b> <font color=\"red\"><b>*<\/b><\/font><br \/>\n    <div class=\"form-group participant-email\"><input class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" name=\"participant-email\" type=\"email\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>City:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n    <div class=\"form-group city\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"city\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>State \/ Province:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n    <div class=\"form-group state-province\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"state-province\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Postal \/ Zip Code:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n    <div class=\"form-group postal\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"postal\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Country:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n    <div class=\"form-group country\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"country\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Association representing:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n    <div class=\"form-group association-representing\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"association-representing\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Select age range and the number of the participants (multiple choice):<\/b> <font color=\"red\"><b>*<\/b><\/font>  For e.g.: If you have 7 people between the age range of Big Kids - 11 to 15 Years, select the button under 6 - 10 ppl.<br \/><br \/>\n   Kids - 5 to 10 Years: <div class=\"form-group agerangeone\"><input class=\"wpcf7-form-control wpcf7-text form-control\" name=\"agerangeone\" type=\"text\" value=\"\" aria-invalid=\"false\"><\/div>\n   Kids - 11 to 15 Years: <div class=\"form-group agerangetwo\"><input class=\"wpcf7-form-control wpcf7-text form-control\" name=\"agerangetwo\" type=\"text\" value=\"\" aria-invalid=\"false\"><\/div>\n   Young Adults - 16 to 25 Years: <div class=\"form-group agerangethree\"><input class=\"wpcf7-form-control wpcf7-text form-control\" name=\"agerangethree\" type=\"text\" value=\"\" aria-invalid=\"false\"><\/div>\n   Adults - 26 to 60 Years: <div class=\"form-group agerangefour\"><input class=\"wpcf7-form-control wpcf7-text form-control\" name=\"agerangefour\" type=\"text\" value=\"\" aria-invalid=\"false\"><\/div>\n   Seniors - 61 Years and above: <div class=\"form-group agerangefive\"><input class=\"wpcf7-form-control wpcf7-text form-control\" name=\"agerangefive\" type=\"text\" value=\"\" aria-invalid=\"false\"><\/div>\n\n<p><b>Previous performance audio\/video\/document links:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n<p>We are looking for audio\/video\/documents links from the past performances to assess the quality and deliverability of the program. Please provide YouTube video links or website url reference below<\/p>\n    <div class=\"form-group performance\"><input class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" name=\"performance\" type=\"text\" value=\"\" aria-invalid=\"false\" aria-required=\"true\" required><\/div>\n\n<p><b>Please accept the terms and conditions before proceeding:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n<p style=\"text-align: justify;\">I acknowledge that this large public event is a place where people from all walks of life are going to be gathered in a confined space. It carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to: actions of other people including, but not limited to, participants, volunteers, spectators, audience, event officials, event monitors and\/or producers of the event; weather, and\/or other natural conditions. I hereby assume all of the risks for myself and on behalf of my team for participating in this event.I certify that I am physically fit, have sufficiently trained for participation in this event and have not been advised otherwise by a qualified medical person. I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by AKKA WKC 2016 and the sponsors of the event in which I may participate and it will govern my actions and responsibilities at aid event. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, release, and discharge from any and all liability for my death, disability personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: AKKA WKC 2016 and their organizing teams, directors, volunteers, sponsors, representatives and agents. (B) indemnify and hold harmless all entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions during this event. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and\/or illness during this event. I understand that I and my team will act professional and conduct ourselves prior, during, and after the event. I further understand that I may be asked to vacate the premises if my conduct doesn't conform to standard and respectable human behavior.\n   <div class=\"form-group wpcf7-form-control wpcf7-acceptance acceptance\"><div class=\"checkbox wpcf7-form-control wpcf7-acceptance acceptance\"><label ><input name=\"acceptance\" type=\"checkbox\" value=\"1\" aria-invalid=\"false\"><\/label><\/div><\/div> I have read, understood, and accept the terms and conditions for the program entry.<br \/><br \/>\n\n<p><b>Please accept the talent release conditions before proceeding:<\/b> <font color=\"red\"><b>*<\/b><\/font> <br \/>\n<p style=\"text-align: justify;\">I authorize the AKKA WKC 2016 to make use of my appearance on my program.I understand that I won't receive any compensation for this appearance. AKKA WKC 2016 shall have the complete ownership of the program. I give the AKKA WKC 2016 the right to use my name, likeness, and biographical material to publicize the program and the services delivered during the program. AKKA WKC 2016 may: (1) Photograph me and record my voice and likeness for the purpose of theproduction mentioned above, whether by film, videotape, magnetic tape, digitally or otherwise; (2) Make copies of the photographs and recordings so made; (3) Use my name and likeness for the purposes of education, promotion or advertising of the sale or trading in the photographs, recordings and any copies so made. (4) Telecast live or at a later time on any broadcast media across the world.I further understand the master copy remains the property of AKKA WKC 2016 and that there will be no restrictions on the number of times that my name and likeness may be used.\n    <div class=\"form-group wpcf7-form-control wpcf7-acceptance acceptance\"><div class=\"checkbox wpcf7-form-control wpcf7-acceptance acceptance\"><label ><input name=\"acceptance\" type=\"checkbox\" value=\"1\" aria-invalid=\"false\"><\/label><\/div><\/div> I have read, understood, and accept the talent release conditions.<br \/>\n\n\n<br \/><br \/><center><div class=\"form-group\"><div><input class=\"wpcf7-form-control wpcf7-submit btn btn-primary\" type=\"submit\" value=\"Submit\"><\/div><\/div>  (Please verify all inputs before clicking on submit)<\/center><div class=\"wpcf7-response-output alert alert-warning\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"class_list":["post-4212","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/pages\/4212","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/comments?post=4212"}],"version-history":[{"count":1,"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/pages\/4212\/revisions"}],"predecessor-version":[{"id":4214,"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/pages\/4212\/revisions\/4214"}],"wp:attachment":[{"href":"https:\/\/akkaonline.org\/2016\/wp-json\/wp\/v2\/media?parent=4212"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}