TAPE ON BACK OF ART SUBMISSION Entrant’s Full Name: Entrant’s Home Address (Street/City/Zip) Entrant’s Home Phone Number (w/area code) Name of School/School Address: (Not applicable if Home Schooled) Contact Phone Number (w/area code): Entrant’s Signature: Parent or Guardian (Printed Name) School Teacher Contact:* Phone: (if submitted via teacher) PARENT RELEASE My child_______________________________________________, has my permission to participate in the Lions Heritage Day / do not (check one) give permission for my child to be video-taped Art Contest. Should my child be a winner, I do and/or photographed for promotional/announcement purposes in the local paper and to be posted on the Emmitsburg Heritage Day and Lions Club Facebook pages and EmmitsburgEvents.com & www.emmitsburg.net/lions and on our twitter accounts. I want to make arrangements to have my art returned to me Yes / No (circle one) Further, I understand that if I answered Yes to the above, I can pickup my art submission between 5pm and 6pm on Saturday, June 27, 2015 or I can make further arrangements to pickup my art submission within 2 weeks after the event. I am responsible to arrange for pick up of said art by contacting Jennifer Joy at 301-447-6467 or by email [email protected]. If I answer No, I relinquish ownership of the art, and it becomes the property of the Emmitsburg Lions Club to dispose of as they deem necessary. Signature of Parent/Legal Guardian _______________________________Date: _____________________________ (Required for submission) CHECK AGE DIVISON: Division 1(elementary school (1st—4th grade)(ages 6-10) Division 2(Middle School (5th—8th grade)(ages 10—13) Division 3(High School (9th—12th) (ages 14– 18)