Texas Teens 4 Libraries 2015 Registration Packet (Important: Teens may only attend IF they are registered by a librarian also attending the TxLA Annual Conference.) Registration Checklist Collect the following in a single envelope and mail to Shawn Mauser, Ann Richards School Library, 2206 Prather Ln., Austin, TX 78704 Copy of each completed teen registration form in alphabetical order by last name (Pg. 2) Copy of each completed chaperone registration form in alphabetical order by last name (Pg. 3) Copy of completed Emergency Contact & Attendee Roster (Pg. 4) Copy of completed Payment Form (Pg. 5) Full payment in form of check, made payable to TxLA, or credit card After mailing the above materials, head to bit.ly/tt4l2015dataform and complete the data form. (Have your copies of the above information at hand before beginning. Important Note: URL is case sensitive.) All registrations must be postmarked by February 27 th, 2015. 1 *TT4L 2015 Logo Designed and Created by Donovan Olsen
Office Use Only: Received Confirmation Sent Texas Teens 4 Libraries (TT4L 2015) Teen Registration Form Thursday, April 16, 2015 from 8:00-2:30 at the Hilton in Austin, Texas 500 East 4th Street, 78701 Registration for teen participation in TT4L is $30. Payment must be submitted to the Sponsoring Librarian. Part 1: Librarian Information (TYPE or PRINT clearly, completing all sections. Submit one form for each teen you are sponsoring for this event. Keep a copy for your records.) Sponsoring Librarian Name Sponsoring Librarian Email Sponsoring Librarian Library Sponsoring Librarian Phone _ Sponsoring Librarian Library Address (Street, City, Zip) As the sponsoring librarian, I will be responsible for this teen s safety and well-being while attending TT4L. I must provide a TT4L orientation for this teen based on guidelines provided by the TT4L Planning Committee. Signature of Sponsoring Librarian Part 2: Student Information (This section is to be completed by the Registering Teen and his or her Parent/Guardian. Please PRINT clearly and neatly. Complete all requested information and return to your librarian by his/her deadline.) Teen First and Last Name Grade Level Teen Home Address (Street, City, Zip) or Homeschooled Teen School (Name and District) T-shirt Size (circle one): S M L XL XXL As the parent or guardian of (teen), I grant permission for TLA to photograph or videotape this teen and release his/her name for publication in TLA sponsored magazines, pamphlets, webpages, blogs, and other instructional materials. Signature of Parent or Guardian Notice: The Texas Library Association and the Young Adult Round Table assume no responsibility for additional expenses incurred by youth, teacher, parent, or other participation in the TLA conference and assume no responsibility for any injury received while traveling to or from the conference or during the conference itself. The Young Adult Round Table will work closely with the librarian in coordinating procedures related to youth and guest participation. 2
Texas Teens 4 Libraries (TT4L 2015) Non-Librarian Chaperone Registration Form Thursday, April 16, 2015 from 8:00-2:30 at the Hilton in Austin, Texas 500 East 4th Street, 78701 Registration for non-librarian chaperone participation in TT4L is $30.00. Payment must be submitted to the Sponsoring Librarian. Part 1: Librarian Information (TYPE or PRINT clearly, completing all sections. Submit one form for each chaperone you are sponsoring for this event. Keep a copy for your records.) Sponsoring Librarian Name Sponsoring Librarian Email Sponsoring Librarian Library Sponsoring Librarian Phone Sponsoring Librarian Library Address (Street, City, Zip) As the sponsoring librarian, I understand that I must provide a TT4L orientation for this chaperone based on guidelines provided by the TT4L Planning Committee. Signature of Sponsoring Librarian Part 2: Chaperone Information (Please PRINT clearly. Please complete all requested information and return to your student s librarian by the deadline.) Non-Librarian Chaperone Name Non-Librarian Chaperone Home Address (Street, City, Zip) OR Homeschool Non-librarian School Affiliation (Name and District) Chaperone T-shirt Size (circle one): S M L XL XXL Notice: The Texas Library Association and the Young Adult Round Table assume no responsibility for additional expenses incurred by youth, teacher, parent, or other participation in the TLA conference and assume no responsibility for any injury received while traveling to or from the conference or during the conference itself. The Young Adult Round Table will work closely with the librarian in coordinating procedures related to youth and guest participation. 3
Emergency Contacts & Attendee Roster This page is to be completed by the Sponsoring Librarian. TYPE or PRINT clearly, completing all requested information. Keep a copy for your records. Sponsoring Librarian: Cell Phone Number: Secondary Emergency Contact: Cell Phone Number: Complete the following section with the names and information of your chaperones and teen attendees. You may attach additional sheets if necessary. Chaperones Notice: You must have one chaperone for every five teen attendees. You are required to give your chaperones an orientation based on the guidelines set forth by the TT4L Planning Committee prior to the event. First and Last Name Cell Phone Number Shirt Size Teens Attending First and Last Name Cell Phone Number Shirt Size 4
Payment Information Sponsoring Librarian must submit one payment for the entire group. Payment may be made by credit card or by check. Total # of Students Attending: x $30 = $ (Registration Fee -- $30/student) Total # of Chaperones Attending (not including sponsoring librarian): x $30=$ (Registration Fee -- $30/non-librarian chaperone) Total Registration Payment enclosed: $ Teen T-Shirts Chaperone T-Shirts (Include one for Sponsoring Librarian) Size Number Size Number S S M M L L XL XL XXL XXL Payment by Check: Make check payable to the TEXAS LIBRARY ASSOCIATION Office Use Only: Check # Amount $ Credit Card Payments: VISA MC AMEX DISC Credit Card Number: Expiration : Mo Yr Card Holder's Signature Mail a copy of each registration form with payment and Emergency Contact/Attendee Roster to: Shawn Mauser Ann Richards School Library 2206 Prather Ln. Austin, TX 78704 All registrations must be postmarked by February 27 th, 2015. 5