2013 Children's Art Contest Entry Form. Complete this form and attach your original artwork with a paper clip (no staple
2013 Children’s Art Contest Entry Form Complete this form and attach your original artwork with a paper clip (no staples) for judging. International category entries may be submitted by mail or by email to Deandra Galarde (
[email protected]). Please Print in Ink. Entrant’s Name: Home Address:
Country: Cell Phone (Parent/Guardian):
Student’s Age:
Home Phone:
Date of Birth:
Grade Level at time art was produced: School at time art was produced: Full Address of School:
Country:
School Phone:
Teacher’s Name: (Entries submitted independent of a school need not include a teacher’s name or contact information.) Teacher’s or home school parent’s signature: Teacher's email: Pediatrician’s Name (If known): Full Address of Pediatrician:
Country: In 25 words or less please tell us what a tobacco-free world means to you.
Please check here if your child is homeschooled (see rules and regulations)
Return to: American Academy of Pediatrics, Children’s Art Contest, 141 Northwest Point Boulevard, Elk Grove Village, IL 60007, USA. MUST BE POSTMARKED BY JULY 31, 2013 Questions? Call (847) 434-7877
