2025 Youth Art Month Celebrate Our Talented Youth 2025 Youth Art Month Registration Student Name * First Student Last Name * Last Grade * KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeNinth GradeTenth GradeEleventh GradeTwelfth Grade School (Full Name) School District Medium Title(s) of Artwork Guardian Name * First Guardian Last Name * Last Guardian Email * Guardian Phone Number * Guardian Address * Guardian Address Guardian Address Guardian Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Consent * I, the PARENT OR GUARDIAN of the above-listed student, hereby grant the irrevocable right and permission to Pickens Arts & Cultural Alliance to use a photograph of my student, my student's artwork, a photograph of my student's artwork, or a photograph taken by my student for publication in media or electronically via the internet or in other displays for education, nonprofit, visual art publications, or exhibitions. I, the ABOVE-LISTED STUDENT, hereby grant that I am over 18 and grant irrevocable right and permission to Pickens Arts & Cultural Alliance to use a photograph of me, my artwork, a photograph of my artwork, or a photograph taken by me for publication in the media or electronically via the internet or in other displays for education, nonprofit, visual art publications, or exhibitions. I understand and agree that such photographs and artwork of my student or by my student (Or me If I am a student over 18) may be placed on the Internet or otherwise published. I also understand and agree that I may be identified by name, grade, and school district in printed, internet or broadcast information that might accompany the photographs or artwork and hereby waive the right to approve these materials. I acknowledge I do not expect to receive compensation. I hereby release, and fully discharge my Pickens Arts and Cultural Alliance, their agents, employees, and representatives from any claims, rights, damages and liabilities arising out of including but not limited or related to any claims for invasion of privacy, appropriation of likeness or defamation. I have read this Release Form, I understand it, and I agree to be bound by it. I also warrant that I am eighteen (18) years old, or, if I am under 18 years old, that my parent or guardian has also signed this release below. Submit If you are human, leave this field blank. Please note that a signed release waiver will need to be signed by each parent at the time of set up prior to your artwork being displayed.
