Brockton Library Suffrage Centennial Art & Poetry Contest

All materials for the Contest must be submitted no later than Friday, July 24 2020 at 8:00pm. A student may enter both art work and a poem using this form, but only one submission is allowed for each.

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* 1. Name of student creating artwork

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* 2. Contact Info

Parent/Guardian Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. What grade will the student be going into in September 2020

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* 4. What school does the student attend?

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* 5. If the submission is art work, very briefly indicate who/what did you draw.

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* 6. Art work attachment

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* 7. What are the dimensions of your art work? Can be no larger than 12"x18"

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* 8. Poetry Attachment

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* 9. By saying "yes" here, the student represents the content you are submitting is completely your sole intellectual property.

Yes

No

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* 10. By saying "yes" here, the parent acknowledges that the student has permission to submit his/her art work or poem and agrees to abide by all terms and conditions of the Brockton Library Suffrage Centennial Art & Poetry Contest.

Yes

No