Special Artist Entry Form

ADVERTISEMENT

National PTA Reflections® Program Student Entry Process
LOCAL PTA INFO
SPECIAL ARTIST ENTRY FORM
Check one:  PTA  PTSA
8-digit PTA ID: __ __ __ __ __ __ __ __
Local
chair name:
Arts Category (Check one):
_________________________________
Official PTA/PTSA name:
Dance Choreography
__________________________________ PTA
address:
Film Production
____________________________________
Literature
City _________________________________
State_______ ZIP ________
Music Composition
E-mail _______________________________
Phone(_____)_________________________
Photography
Local PTA good standing status:
Membership
dues paid date __/__/__
Insurance paid date
Visual Arts
__/__/__
Bylaws approval date __/__/__
Teacher:________________________________________________________________________________________________
Artwork Title:
Artist Statement (At least 10 words; maximum 100 words):
Gender (Circle one):
Male
Female
Student First Name:
Student Last name:
Parent Guardian Name:
Parent/Guardian Address:
City, State Zip:
Parent/Guardian Email:
Parent/Guardian Phone:
I grant to National PTA an irrevocable, unlimited license to display, copy, sell, sublicense, publish, and create and sell derivative
works from, my work submitted for the Reflections Program. National PTA is not responsible for lost or damaged works. Entries may
not be returned. I understand that I must participate in the Reflections Program through a PTA/PTSA in good standing. I affirm that
this is my own original work. I understand that the submission of my entry into the Reflections Program constitutes acceptance of
the above conditions.
→________________________________________→______________________________________________________________
Full signature of student
Signature of parent/legal guardian (necessary if child is under 18 years)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2