Polk Soil and Water Conservation District 2012 Poster & Photo Contest Entry Form
Polk SWCD 580 Main Street, Suite A Dallas, OR 97338
STUDENT First Name______________________ Last________________________ Poster Contest Address______________________________________________________ Check appropriate City _________________________ State ___________ Zip ___________ age group Phone (___) ______________ E-mail _____________________________ School Name _________________________ Grade ______ Age_________ ___K-1 ___2-3 _____ The poster/photo is an original completed by the student. ___4-6 ___7-9 _____ The student received assistance from another person or materials/ideas ___10-12 from another source. If yes, please explain on another piece of paper. 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 ____________ Signature SCHOOL INFORMATION Teacher ____________________________________________ Check: Public School ____ Private School ____ Home School ____ Address ____________________________________ Phone (____)____________ City ____________________State __________ Zip _____________
Polk Soil and Water Conservation District 2012 Poster & Photo Contest Entry Form
Polk SWCD 580 Main Street, Suite A Dallas, OR 97338
STUDENT First Name______________________ Last________________________ Poster Contest Address______________________________________________________ Check appropriate City _________________________ State ___________ Zip ___________ age group Phone (___) ______________ E-mail _____________________________ School Name _________________________ Grade ______ Age_________ ___K-1 ___2-3 _____ The poster/photo is an original completed by the student. ___4-6 ___7-9 _____ The student received assistance from another person or materials/ideas ___10-12 from another source. If yes, please explain on another piece of paper. 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 ____________ Signature SCHOOL INFORMATION Teacher ____________________________________________ Check: Public School ____ Private School ____ Home School ____ Address ____________________________________ Phone (____)____________ City ____________________State __________ Zip _____________
Polk Soil and Water Conservation District 2012 Poster & Photo Contest Entry Form
Polk SWCD 580 Main Street, Suite A Dallas, OR 97338
STUDENT First Name______________________ Last________________________ Poster Contest Address______________________________________________________ Check appropriate City _________________________ State ___________ Zip ___________ age group Phone (___) ______________ E-mail _____________________________ School Name _________________________ Grade ______ Age_________ ___K-1 ___2-3 _____ The poster/photo is an original completed by the student. ___4-6 ___7-9 _____ The student received assistance from another person or materials/ideas ___10-12 from another source. If yes, please explain on another piece of paper. 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 ____________ Signature SCHOOL INFORMATION Teacher ____________________________________________ Check: Public School ____ Private School ____ Home School ____ Address ____________________________________ Phone (____)____________ City ____________________State __________ Zip _____________
Polk Soil and Water Conservation District 2012 Poster & Photo Contest Entry Form
Polk SWCD 580 Main Street, Suite A Dallas, OR 97338
STUDENT First Name______________________ Last________________________ Poster Contest Address______________________________________________________ Check appropriate City _________________________ State ___________ Zip ___________ age group Phone (___) ______________ E-mail _____________________________ School Name _________________________ Grade ______ Age_________ ___K-1 ___2-3 _____ The poster/photo is an original completed by the student. ___4-6 ___7-9 _____ The student received assistance from another person or materials/ideas ___10-12 from another source. If yes, please explain on another piece of paper. 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 ____________ Signature SCHOOL INFORMATION Teacher ____________________________________________ Check: Public School ____ Private School ____ Home School ____ Address ____________________________________ Phone (____)____________ City ____________________State __________ Zip _____________