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Student Information/Release Form
Note: This form is used for printing of programs and certificates. Please make sure all information is complete and correct.
| art student’s name: |
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| age/grade: |
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| name of parent or guardian: |
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| home address: |
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| city, state, zip: |
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| phone(s): |
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| school: |
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| art teacher: |
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| school address: |
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| art teacher phone: |
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| title of entry: |
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| medium (be specific): |
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| framed dimensions: |
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| Artwork Release |
In consideration of your acceptance of an art entry in Kahu‘Aina sponsored by Princeville Center/Honu Group, and intending to be legally bound hereby, the undersigned grant you our consent for public display in accordance with the rules of the Art Competition of said art entry if selected in accordance with the rules of the Art Competition. The undersigned hereby releases you and your agents from any and all liability for damage, loss, or misappropriation of the art entry. The undersigned further represents that this art entry is an original work of art personally executed by the entrant for which the entrant has secured, or is entitled to secure a copyright. The undersigned further grants Princeville Center/Honu Group, the right to authorize and include this work in a derivative work, such as a compilation wherein this work is depicted as one of a set representing the competition, Kahu‘Aina. Notwithstanding the above, the undersigned shall retain all proprietary rights, including but not limited to, legal title, and beneficial copyright ownership in the art entry during and subsequent to the Art Competition, but grant you and your agents gratuitous license to use the art entry and photocopy or reproduce the same for any non-commercial purpose. The undersigned further agrees to indemnify and hold harmless, Princeville Center/Honu Group and partners against any and all claims of any nature whatsoever, including any relating to copyright infringement, by any party whatsoever, arising out of or in any way related to this agreement and the display thereunder of the proffered art entry. The final decision regarding the suitability of an entry to be displayed in Princeville Center/Honu Group will be made by a panel. Should I win, I agree to allow my entry to be used as banner for the Princeville Center/Honu Group.
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Parent/Guardian Signature and Date
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Student’s Signature
and Date
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