RIDOH Swim Safety Art Contest

1

Student's First Name * Student's Last Name *

2

Student's Grade Level

K-5

6-8

9-12

3

Home Town *

4

Student's or Parent's Email

example@example.com

5

Title of Art Piece *

6

Description of Art Piece

7

I have read and agree to the following consent: I hereby grant permission for my child to participate in the Rhode Island Department of Health (RIDOH) Swim Safety Art Contest or confirm that I am a student who is 18 or older. By entering, I acknowledge that the artwork is an original creation and has not been copied, reproduced, or derived from any other source. I grant the RIDOH and the State of Rhode Island permission to use my/my child’s artwork in its photographs, videos, website, publications, and any other media. I understand that my artwork may be used for an indefinite period. I waive any right I may have to inspect or approve the final product or its use and will make no monetary or other claim against RIDOH for the use of the media.

YESNO

8

Parent's or Youth 18 Signature

9

Submit this form and then email your artwork to STAGESOFFREEDOM@AOL.COM with the subject line "RIDOH Swim Safety Art Contest." Include the child's name in the email.

Videos should be no longer than 30 seconds and digital images must not exceed 100 MB. Artwork should be age-appropriate and focused on encouraging safe and responsible behavior – please do not submit any graphic or frightening imagery.