Student Release Form

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New Jersey State Teen Arts
Student Release Form
           
Student's Name          
Age     Grade    
Home Address          
City   State:  NJ Zip  
Home Phone (           )        
Home Fax (           )        
Email Address          
Teacher's Name          
School's Name          
School's Address          
City   Zip   County: Salem
           
VISUAL ARTS LITERARY ARTS
Title     Title    
Medium          
Size (Height x Width)        
Estimated value          
I understand and agree that Friends of Teen Arts, Inc. (FOTA) may display and/or reproduce my work in any or all of its publications and outreach efforts including but not limited to the Touring Art Exhibit, Calendar, and Anthology. Pieces on tour will not be returned until the fall of 2008. I understand and agree that my writing may be replicated in the New Jersey State Teen Arts Creative Writing Anthology and/or used in other Teen Arts Publications and public relations efforts.
Student's Signature        
Adult's Signature