Please print clearly.
Name: ___________________________________________________________________
Date: _______________________
Address: ____________________________________________________________________________
Phone number: __________________________
Email Address: ________________________________________________
Grade: _____________ Teacher: ____________________________________________________________
School: ____________________________________________________________________________
College you will be attending: ____________________________________________________________________________
Liability: The Medina County District Library does not accept liability for damage or loss to any artwork regardless of reason.
I understand and agree to all the rules.
___________________________________________________________________________
student’s signature