Salt Lake City Police Department Student Art Contest Official Entry Form

Note: An Official Entry Form must accompany each submission. One entry per person.

Contact Information Name: Address: City: Phone Number(s): Email: School: Age: State: Grade: T-shirt Size: Zip:

Alternate Contact Information (i.e., parent or guardian) Name: Address: City: State: Zip: Phone Number(s): Email Entries accepted at basket in main office thru March 30, 2012 Title of Artwork Submitted: Please complete the following sentence: This anti-drug public service advertisement will provide the community the message of:

Artwork/Photo Release By signing below you and your guardian agree to release the rights to your artwork and any photos taken of you at press conferences or other events to the Salt Lake City Police Department for promotional purposes. Student Signature: Guardian Signature: Date: Date:

*All artwork submitted with photographs of individuals must provide a release from the individual and/or their guardian.

Questions? Contact Lara Jones (801) 799-3340 lara.jones@slcgov.com