ACS Funky Junk Art Contest Registration Form

School CWES

Grade Kindergarten

Age_____________________

Title of Work ____________________________________________________

Artist’s Statement_________________________________________________

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________________________________________________________________

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(you may attach additional sheets if necessary)

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Entry # (completed by school) ____________

Student’ Name ________________________________Teacher S. Jones

Address _________________________________

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Phone Number _________________________________

Email _________________________________

I grant the PTO Elementary Arts Council permission to use my works for commercial or noncommercial

use, including without limitation, public presentation of the work and reproductions of the work in print,

electronic and multimedia formats to promote the ACS Art Program. The PTO Elementary Arts Council is

not responsible for lost or damaged works. We will try to return all entries.

I affirm that this is my own original work. I understand submission of my entry to the ACS Funky Junk

Art Contest constitutes acceptance of these conditions.

___________________________________ ________________________________

Signature of student Signature parent/legal guardian

To be completed by school Entry # ________ Grade Division: (circle)

k-2 3-5 6-7 8-9 10-12