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2012-13 Hildegard Center for the Arts "Heroes Among Us" Competition Participation Entry Form

All fields must be completed. Enter N/A if necessary.

Name of Entrant

Title of Submission

Home Address

City, State

Zip Code

Entrant Age


Home Phone

Cell Phone

Email Address of Entrant

Entrant School/Site

School/Site Address


Email Address of Teacher/Facilitator (MUST BE A VALID EMAIL)

Phone Number of Teacher/Facilitator

Name of Parent/Guardian

Home Phone of Parent

Cell Phone of Parent

Email Address of Parent

Hero portrayed in entry (if applicable)

Address of Hero (if known)

(check mark required) I hereby certify that to the best of my knowledge and understanding, the Competition entry submitted by the above named entrant is entirely the work of the entrant and is an original creation-not a copy of a previously produced work. I have read the guidelines of this contest and will abide by these rules with the understanding that a failure to do so will disqualify the entrant from this contest. I certify that all necessary releases and permissions arising from this competition submission have been secured and are included with this entry form. I hereby expressly grant to Hildegard Center for the Arts (in Lincoln, NE) and Arts are Basic (in Lincoln, NE) the right to publish and publicize the name and likeness of the entrant in conjunction with this Competition and use the entrant's name and image on website postings and for publication and promotional purposes. I hereby give permission to the Hildegard Center for the Arts and Arts Are Basic to use the entrant's competition entry for publication, display, promotional, publicity and educational purposes, giving creative credit to the entrant. I will not hold Hildegard Center for the Arts, Arts Are Basic, the Boards of Directors or volunteers responsible or liable for any actions, negligence, accident or vandalism arising form this Competition or subsequent exhibits, publications or promotions.

File Upload (2MB max file size)

PLEASE NOTE: Your application is submitted when you click the send button, though the arrow icon will continue to cycle. Please submit Word documents only. Check your email for confirmation of delivery. You should receive your confirmation within a few minutes.   If your submission is NOT confirmed, please contact Heroes Chair Anne Woita immediately at 402-890-2528 or email  Thank you!