Reflections 2022 Palmetto Middle School Student Entry Form

Palmetto Middle PTA Reflections Entry Form

Please fill out this form for your entry for online submission
DATE

MonthDayYear
Date
STUDENT NAME
GRADE
AGE
CLASSROOM
PARENT/GUARDIAN NAME
EMAIL
example@example.com
PHONE
Address

MAILING ADDRESS

Street Address Line 2

CITYSTATE

ZIP
ARTS Category (Check One)

DANCE CHOREOGRAPHYFILM PRODUCTIONLITERATUREMUSIC COMPOSITIONPHOTOGRAPHYVISUAL ARTS
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.
STUDENT SIGNATURE

Clear
PARENT/GUARDIAN SIGNATURE

Clear
TITLE OF WORK
DETAILS
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)
ARTIST STATEMENT (In 10 to 100 words, describe your work and how it relates to the theme)
PT/F
Should be Empty:

Palmetto Middle PTA Reflections Entry Form