IV Międzynarodowy Konkurs Plastyczno

APPLICATION FORM *
Name of the author of the work:
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Age: …………..………
Title of the work :
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Name and address of school or institution guiding the work for the Contest:
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Information concerning the patron under whose supervision the work was
created:
Name:
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………………………….
Telephone: ………………………………………………………..
E-mail: ………………………………………………....................
I declare that I have read the content of the Contest Regulations and I accept all of its
provisions.
I declare that the work submitted by me constitutes the sole property of the Organizers of the
Contest and does not violate the rights of third persons; I also transfer to the Organizers sole
rights to manage the work according to the provisions of the Contest Regulations.
I consent to the processing of my personal data / my child’s data in order to carry out the
Contest, in accordance with Decree of 29 August, 1997 referring to the protection of personal
data (Decree of 2002, nr 101, item 926 with later amendments).
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date and signature of the patron (teacher)
date and signature of the contestant
or legal custodian in case the
contestant is a minor
* completed Application Form should be pasted on the reverse of each entry