Flag Release Form

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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.      

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