Youth A rt M onth -‐ S tudent A rtwork/Flag R elease F orm
I agree to allow my artwork and/or flag to be a part of state and national art exhibits for Youth Art Month. As part of this
participation, artwork a nd/or flag m ay be d isplayed i n t he n ews m edia o r e lectronically v ia t he i nternet or in other displays f or
educational, non-‐profit, visual art publications, and exhibitions. Artwork may also be displayed, photographed and/or
.
published f or C ouncil f or A rt E ducation, i ts w ebsite a nd o ther s ocial m edia o utlets
YES N O
Suggestion – M ake 3 c opies o f t he c ompleted E ntry F orm f or e ach a rtwork. A ttach 2 c opies
to t he b ack o f t he a rtwork ( one w ill r emain p ermanently o n t he a rtwork a nd o ne w ill b e
removed f or Y outh A rt M onth f iles. K eep t he t hird c opy f or y our r ecords.
I a gree t o a llow m y n ame, g rade, s chool d istrict, a nd p hotograph t o b e u sed i n t he n ews m edia o r e lectronically v ia t he i nternet
or in other displays for educational, non-‐profit, visual art publications, and exhibitions. Photographs may also be displayed
and/or p ublished f or C ouncil f or A rt E ducation, i ts w ebsite a nd o ther s ocial m edia o utlets.
YES N O
If y ou a nswer Y ES t o a ny o f t he q uestions, a c opy o f t his f orm M UST b e s ubmitted t o C ouncil f or A rt E ducation a t
y
.
STUDENT N AME _ __________________________________________________ G RADE _ _____________
TITLE O F A RTWORK _ _______________________________ M EDIUM_____________________________
SCHOOL D ISTRICT _ _____________________________________________________________________
SCHOOL ( Full N ame) _ ___________________________________________________________________
SCHOOL A DDRESS _ _____________________________________________________________________
CITY _ ________________________ S TATE _ ____________ Z IP _ ___________ P HONE _ ______________
Dr. M r. M rs. M s. T EACHER _ ______________________________________________________________
TEACHER E MAIL _ ______________________________________________________________________
TEACHER P HONE _ ____________________________NAEA M embership # ________________________
Dr. M r. M rs. M s. P RINCIPAL’S N AME _ ______________________________________________________
STUDENT S IGNATURE _ __________________________________________________________________
PARENT N AME _ _______________________________________________________________________
PARENT S IGNATURE _ ___________________________________________________________________
(Required i f s tudent i s u nder 1 8 y ears o f a ge)
PARENT E MAIL _ ______________________________________________________________________
*
STUDENT A DDRESS _ ____________________________________________________________________
CITY _ _____________________________________________ZIP _ _______________________________
HOME P HONE # _ ______________________________________________________________________
This f orm m ust a ccompany a ll a rtwork a nd f lag d esign s ubmissions.