Application Form
PAROLISSIMA 2017: Words & Images
UN  RICORDO NELLA VITA DEI NONNI
SOUVENIRS  OF MY GRANDPARENTS
(This form must accompany entries)

Name: (First) ____________________________________________________________
 

(Last)_____________________________________________________________
Home Address:
____________________________________________________________

City: __________________
 
Province:_______________Postal Code: ____________

Contact Number:______________________

    Alternate Number:(____________________)

E-mail Address: _________________________________________________

Age: _______________ Male: ______ Female: _____

Entry Type:

    Drawing______

 Video_________

Centro Giovanile Formativo Italocanadese      Grade _____

    Frank Ryan International Languages Program-Italian   Grade _____

    Community    Grade_____

         Parent/Guardian Consent  I,_________________________________________
(Parent/Guardian),

           give permission to _____________________________________ (Child’sName)

to participate in the Competition
PAROLISSIMA 2017: Words & Images
.
The above-mentioned participant and I have read, understood and will
comply with the Contest Rules and Procedures.
I understand that I am fully responsible for my child’s safety and well
being and will not hold the members of the Gruppo Culturale Parolissima,
Organizing Committee or the facility owner/operator, responsible
for any damage or injury to myself or my
child, howsoever caused. I also authorize the GruppoCulturaleParolissima,
Organizing Committee to use, at their discretion, copies of the drawings/videos
and photographs of my child in the context of the event, in various forms of media,including the website of the Gruppo Culturale Parolissima
at: www.parolissima.com
for purposes of reporting on and promoting
PAROLISSIMA: Words & Images.

Signature of Parent /Guardian:
________________________________Date:__________________

Bonne chance! Good luck! In bocca al lupo