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Printable registration form for Heart Art

logoChild Abuse Prevention Association

P.O. Box 531 Beaufort, S.C. 29901

                                                            A United Way Agency

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CAPA’s Heart Art Contribution

Artwork Release Form

Please complete this form and return it with your child’s art to CAPA’s Closet Thrift Store (near Bi-Lo at Parris Island Gateway) or to CAPA’s Outreach Center (call 524-4350). 
(A separate form must accompany each drawing). 

Child’s Name (please print) _________________________Child’s Age ____

Mailing Address______________________________________________

__________________________________________________________

Telephone _____________________________________

Parent/Guardian’s Name __________________________________

Child’s School or children’s organization ___________________________

Title of child’s drawing ____________________________________

I understand and agree to the terms of the agreement as listed below.

I grant permission to the Child Abuse Prevention Association (CAPA) to use the enclosed artwork in any CAPA publications or publicity related to CAPA or to its purposes or activities.

Parent/Guardian Signature_________________________________ Date_________

Please attach this form to back of each drawing.

  • Drawings submitted to CAPA will not be returned
  • CAPA will not notify regarding receipt of materials
  • CAPA will hold the sole copyright to all materials received by it and will not accept materials copyrighted by third parties
  • CAPA may grant permission for materials included in CAPA publications to be reproduced elsewhere without separate permission, provided that an accurate citation is given to CAPA and its publication
  • CAPA does not guarantee that material received will be published
  • CAPA reserves the right to edit or alter the submissions without additional consent
  • CAPA reserves the right to create derivative works without additional consent
  • CAPA will be held harmless in all matters pertaining to the materials accepted and published

CAPA will be exempt from any costs related to materials’ submission, unless agreed to in writing prior to the date of receipt