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Imagine This! Discovery Awards Submission

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NAME:

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EMAIL:

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Parent Email (if different from participant):

For children under the age of 12 we prefer to have all communication go directly through the parent and the parent's email rather than communicating with the child.

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Age:

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Submission Category:

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Submission #:

Your submission # is the first 3 letters of the submission category, dash, your age, dash, the first 3 letters of your last name. (Example: 6 year old Kadence Smith submitting an entry in photography would be pho-6-smi

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Artist's Statement

Please include a description of your work including any specifics on the art form used, the background of why you chose this particular category and/or project, and any story that goes with it.

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PARENT RELEASE: Parent Name is required in the box below.

I hereby grant My Discovery Destination! permission to use my child's likeness and/or any likeness of his/her Imagine This! Discovery Award entry in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of My Discovery Destination! I hereby irrevocably authorize My Discovery Destination! to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my child's likeness or a likeness of his/her entry appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge My Discovery Destination! from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHIOTO RELEASE. I AFFIRM THAT I HAVE CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR NAMES TYPED BELOW. I ACCEPT: