Frame of Mind - Art Exhibition Entry Form - November 2022

CONTACT DETAILS

INSTRUCTIONS:

Step 1: Read through the artist pack guidelines

Step 2: Complete the below form in full and submit by Friday 2nd December.

Step 3: Please email an image of your work to shelly.morrison@inspiro.org.au by Friday 2nd December.

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* 1. Young persons contact details

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Parent/guardian contact details (if under 18)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 3. Your experience with mental health challenges

I am a young person who has experienced or is experiencing mental health challenges

I have family or a friend who has had an experience or is experiencing mental health challenges

I am a carer for someone who has had or is having and experience with mental health challenges

Other (please specify)

None of the above

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* 4. As this exhibition explores mental health, please tell us a little bit about your journey (this might include any diagnosis, treatment, what has helped/is helping you recover, the people or places that have helped you, future goals)

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* 5. Would you like your experience above displayed with your art work?

Yes

Other (please specify)

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* 6. What supports do you have in place? (eg: GP, counsellor, psychologist, psychiatrist, case manager, family, friends, school supports)

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* 7. Are you a client of the Lilydale Youth Hub (eg; do you have a case manager or counsellor)

Yes

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* 8. Your Artwork!

Artist name. You can choose how this is displayed with your artwork (eg. full name, first name, a pseudonym (made up name) or leave this blank to be anonymous)

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* 9. Artwork title

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* 10. Provide details of your artwork inspiration (eg. what inspired you, the meaning behind it)

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* 11. Would you like your inspiration/burb displayed with your artwork?

Yes

Other (please specify)

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* 12. Artwork medium (eg. acrylic, ceramic, digital, photograph, video)

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* 13. Artwork size

Width

Height

Video length

Poetry or story (number of words)

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* 14. Is your artwork for sale?

Yes

If "yes" artwork price $

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* 15. Terms & Conditions

I give consent for photos and/or videos of my artwork to be used on our website

I give consent for photos and/or videos of my artwork to be used on our social media

I give consent for photos and/or videos of my artwork to be used in advertising

I give consent for my Artist Name to be included alongside my artwork

By completing this entry form, the artist acknowledges that:

* They must drop off their artwork to Lilydale Youth Hub by Monday 12th December
* They must they must pick up their artwork from Lilydale Youth Hub by Thursday 22nd December. LYH cannot guarantee that the artwork remains at the hub after this date.
* That while the upmost of care will be taken with artwork, the Lilydale Youth Hub can take no responsibility for any damage that may occur to their artwork during the exhibition

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* 16. Confirmation of entry

I certify that I have completed this form and that all details are true and correct.

Full name:

Signature:

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* 17. If this form has been completed on behalf of the artist, I certify that all details are true and correct and have been completed with the artist’s permission.

Full name:

Relationship to young person:

Signature:

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* 18. Thank you for completing the entry form. The hub will be in contact with any further questions or queries about your entry. Should you have any questions please don't hesitate to call the hub on 9757 8777 or email shelly.morrison@inspiro.org.au

Frame of Mind - Art Exhibition Entry Form - November 2022

CONTACT DETAILS

Question Title

* 1. Young persons contact details

Question Title

* 2. Parent/guardian contact details (if under 18)

Question Title

* 3. Your experience with mental health challenges

Question Title

* 4. As this exhibition explores mental health, please tell us a little bit about your journey (this might include any diagnosis, treatment, what has helped/is helping you recover, the people or places that have helped you, future goals)

Question Title

* 5. Would you like your experience above displayed with your art work?

Question Title

* 6. What supports do you have in place? (eg: GP, counsellor, psychologist, psychiatrist, case manager, family, friends, school supports)

Question Title

* 7. Are you a client of the Lilydale Youth Hub (eg; do you have a case manager or counsellor)

Question Title

* 8. Your Artwork!Artist name. You can choose how this is displayed with your artwork (eg. full name, first name, a pseudonym (made up name) or leave this blank to be anonymous)

Question Title

* 9. Artwork title

Question Title

* 10. Provide details of your artwork inspiration (eg. what inspired you, the meaning behind it)

Question Title

* 11. Would you like your inspiration/burb displayed with your artwork?

Question Title

* 12. Artwork medium (eg. acrylic, ceramic, digital, photograph, video)

Question Title

* 13. Artwork size

Question Title

* 14. Is your artwork for sale?

Question Title

* 15. Terms & Conditions

Question Title

* 16. Confirmation of entry I certify that I have completed this form and that all details are true and correct.

Question Title

* 17. If this form has been completed on behalf of the artist, I certify that all details are true and correct and have been completed with the artist’s permission.

Question Title

* 18. Thank you for completing the entry form. The hub will be in contact with any further questions or queries about your entry. Should you have any questions please don't hesitate to call the hub on 9757 8777 or email shelly.morrison@inspiro.org.au

* 8. Your Artwork!

Artist name. You can choose how this is displayed with your artwork (eg. full name, first name, a pseudonym (made up name) or leave this blank to be anonymous)

* 16. Confirmation of entry

I certify that I have completed this form and that all details are true and correct.