Entry Form and Photo Release
Saturday, March 16, 2024
11 AM - 3 PM
Champlain Centre Mall 
60 Smithfield Blvd, Plattsburgh, NY 12901

All entries must be received by 4 PM March 8, 2024
Please direct any questions about entries to Stephanie Larkin at slarkin@lcbp.org  

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Name of School, Homeschool Group or Youth Group *
Mailing Address *
Name of Teacher or Group Leader *
email address *
Entry Title
Grade level *
Required
Category *
Required
Presentation Form: may check more than one *
Required
If completing an entry in videography, provide URL to YouTube video:  
Artist statement:  Ideas for things to consider:  •  why did you choose this topic and what does it mean to you?   •   what do you hope it will mean to anyone viewing or reading your work?  *
Photo Release:  I authorize the Lake Champlain Basin Program (“LCBP”) to use images of the people named below for LCBP related print and electronic publications and materials, without limitation, as LCBP shall in their sole discretion determine. This authorization is without date restriction. LCBP agrees that this photograph will not be given or sold to any individual or organization and will only be used for LCBP educational and informational purposes. 
Please list name/s of person/people appearing *
Adult Person Appearing or Parent/Guardian* of Minor Person Appearing (*I represent that I am the Parent/Guardian of the Minor Person Appearing as named above and agree that we both shall be bound by this Agreement):    *
Name of person authorizing and date: 
Mailing Address:  *
Phone number:  *
email:  *
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