Youth Art Show Release Form

YOUTH ART SHOW GUARDIAN RELEASE FORM

To Be Completed and Attached To Back Of Each Piece Of Art Work (Please Print Clearly)

Description of Art Work___________________________________________________

Student Name___________________________________________________________

School______________________________________________Grade______________

Address________________________________________________________________

City_______________________________State_________________Zip_____________

Phone Number_______________________ Cell Number ________________________

Email Address__________________________________________________________

Parent / Legal Guardian___________________________________________________

I give permission to the Pioneer Cellular Smokin’ Red Dirt Arts Festival to exhibit the work of the above named student at the Youth Art Show exhibit April 4-15, 2017, if  the named student qualifies and / or at the Youth Art Show exhibit during the Smokin’ Red Dirt Arts Festival.

 Parent / Legal Guardian Signature_____________________________

Date______________

_______________

 Student Name

______________

Grade

______________

School