Polk Soil and Water Conservation District
STUDENT
First Name______________________ Last________________________ 2012 Poster & Photo Contest Entry Address______________________________________________________ Attach to back of poster or photo City _________________________ State ___________ Zip ___________ Phone(___) ______________ E-mail _____________________________ Due by: October 3rd, 2012 School Name _________________________ Grade ______ Age_________ _____ The poster/photo is an original completed by the student. _____ The student received assistance from another person or materials/ideas from another source. If yes, please explain on another piece of paper
Form
PARENT Parent or Guardian Name (printed) ________________ Last_______________________ As parent or guardian, I allow NACD/District to utilize the poster/photo for educational or promotional purposes. _____________________________ Date ____________
SCHOOL INFORMATION
Signature
Teacher ____________________________________________ Check: Public School ____ Private School ____ Home School ____ Address ____________________________________ Phone (____)____________ City ____________________State __________ Zip _____________
CONSERVATION DISTRICT Polk Soil & Water Conservation District 580 Main Street, Suite A Dallas, OR 97338 503-623-9680 polk.swcd@polkswcd.com
Additional information available at http://www.nacdnet.org/education/contests/
Poster Contest Check appropriate age group
____K-1 ___ 2-3 ___ 4-6 ___ 7-9 ____10-12
Photo Contest Only one category 18 and younger Photo Location: City__________ State______ Photo Description: _____________________ Example: Garden Growing If people in photo, contact Polk SWCD for Subject Release form (not eligible without)