Enter the 24th Annual Art Contest

The deadline to receive all artwork and completed applications has been extended to July 15, 2019.

ARTIST'S INFORMATION

Title of Artwork

Please provide a short description of the artwork.

Artist First Name

Artist Last Name

Birthdate (MM/DD/YYYY)

Gender
Male
Female

Please upload a recent close-up photo of the artist

Parent/Guardian Phone

Parent/Guardian Email

Address

City

State

Zip

MEDICAL FACILITY INFORMATION

Dialysis/Medical Facility Name

Dialysis/Medical Facility Phone Number

Dialysis/Medical Facility Contact Name and Title

Dialysis/Medical Facility Email Address

Dialysis/Medical Facility Address

Dialysis/Medical Facility City

Dialysis/Medical Facility State

Dialysis/Medical Facility Zip

Artist is Currently




If Artist is a Kidney Disease Patient or Other as noted above, what type?

Dialysis Information
If on dialysis, please indicate your child's usual treatment days.







School Information



Grade Level

ENTRY INFORMATION

Answer the questions below with as much information as you can.

Where did you get the idea for your art?

What made you decide to enter the calendar contest?

What hobbies do you have?

Who is your role model and why?

FOR KIDS 12 AND OLDER: What are your plans after high school? (college, career, etc.)

FOR KIDS UNDER 12: What do you want to be when you grown up?

How is your day-to-day life affected by kidney disease?

What advice would you give to other kids with kidney disease?

How has a friend, family or celebrity inspired you to deal with your disease?

What type of artwork is being submitted?
 Drawing or Painting
 Song Performance
 Dance Performance
 Short Film
 Poem or Short Story

Please select one of the two options below to provide a file or a link to the artists work.

Upload a picture of your drawing, painting, poem or short story.

If you uploaded your video or film to YouTube, please share the link.

GENERAL RELEASE, CONSENT, AND ASSIGNMENT

Signature is required by parent/legal guardian
I/we am/are the custodial parent(s) and/or legal guardian of the child submitting this artwork, hereinafter "my/our" child.

In consideration of participation in the Events and/or Activities, I/we grant to the American Kidney Fund full rights to take pictures, photographs, and/or video (including recordings) of my/our child in connection with the Events and/or Activities, and to make use of such pictures, photographs and/or videos as the American Kidney Fund shall deem appropriate. I/we understand that the copyright to all such pictures, photographs and/or video shall be and remain the exclusive property of the American Kidney Fund. Further, I/we grant permission to the American Kidney Fund, without limitation, the right to collect and use information about my/our child.

I/we further grant and assign to the American Kidney Fund the exclusive copyright and all otehr property rights in and to the art created by my/our child in order that the American Kidney fund may make sure of it in the calendar it will publish and in such other publications as the American Kidney Fund shall deep appropriate in the exercise of its sole discretion. I/we understand that no payment, royalty, or other consideration will be paid by the American Kidney Fund in return for the copyright to the art which is an absolute and unconditional gift to the American Kidney Fund.

Parent or Legal Guardian

Signature Date (MM/DD/YYYY)

Parent or Legal Guardian 2

Signature Date (MM/DD/YYYY)

Please type the letters that you see in the box:

Please hit the submit button only once. The confirmation page may take some time to load depending on the file size of your artwork.