Lake County America 250
Art and Essay Contest Entry Form

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* 1. Authorization

I hereby authorize Lake County, Illinois to use, reproduce, publish, distribute, adapt and publicly display, the essay or artwork of the student named below for purposes related to the Lake County America 250 Art and Essay Contest, in any and all languages and editions, including electronic/digital languages.

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* 2. Student Information

Name

Age

Grade

Student Signature

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* 3. Parent/Guardian Information

Name

Signature

Email Address

Phone Number

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* 4. Address

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* 5. School or Organization Information

School & District or Organization Name

School or Organization Phone Number

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* 6. Certification and Release

I hereby certify and represent that, any typed signatures above serve as electronic signatures, I agree to the contest rules, and to the best of my knowledge, the essay or artwork of the student named above is an original work of authorship personally created by the student to which the student is entitled copyright protection under 17 U.S.C. § 101 et seq., and that it is not copied from, nor does it include, any other person’s copyrighted work in part or in whole. I further affirm that the essay or artwork was not created using any generative artificial intelligence (AI).

Lake County America 250 Art and Essay Contest Entry Form

Question Title

* 1. Authorization

Question Title

* 2. Student Information

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* 3. Parent/Guardian Information

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* 4. Address

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* 5. School or Organization Information

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* 6. Certification and Release

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* 7. Art or Essay File Upload

Lake County America 250
Art and Essay Contest Entry Form