Wolftrap Elementary School PTA (Reflections 2021-2022)

Wolftrap Elementary School PTA Reflections Entry Form
This is the Reflections Entry Form for Wolftrap Elementary School. If your entry is for another school please contact your Reflections coordinator to obtain access to the correct form. This form must be filled out and submitted by an individual who is at least 13 years old. Both the student and a parent/guardian must sign this form in the appropriate fields below.

Please contact wendy.l.rosner@gmail.com if you have any questions or issues.
Student Name *

First Name Last Name
Grade *
Age *
Homeroom Teacher
Parent or Guardian Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Agreement
Ownership in any submission shall remain the property of the entrant, but entry into this program constitutes entrant’s irrevocable permission and consent that PTA may display, copy, reproduce, enhance, print, sublicense, publish, distribute and create derivative works for PTA purposes. PTA is not responsible for lost or damaged entries. Submission of entry into the PTA Reflections program constitutes acceptance of all rules and conditions. I agree to the above statement and the National PTA Reflections Official Rules.

Filling out student and parent/guardian names below indicates agreement with the above statement and National PTA Reflections Official Rules. Please note that the student and parent/guardian may be asked to submit an paper version of the entry form if the entry reaches the Virginia State PTA level of Reflections. Also, retain originals of the entry for at least one year in case the original entry is requested.
Student Signature *

Clear
Parent/Guardian Signature *

Clear
Title of Work *
Grade Division *
Arts Category *
Details
Required Information in Artist Statement
If background music is used in dance/film, citation is required. Include word count for literature. List musician(s) or instrumentation for music. List dimensions for photography/visual arts.
Artist Statement (In 10 to 100 words, describe your work and how it relates to the theme) *
Entry file(s) *

Cancel of
Should be Empty:

Wolftrap Elementary School PTA Reflections Entry Form

Agreement

Required Information in Artist Statement