Wild Card Participants for Visual Poetry Jam

Your Name *

First

Last

I am a : *

Student
Teacher/Youth worker

Your Age (If you are a student)

eMail *

Email

Confirm Email

Your Mobile Phone Number

So we can contact you if we have any issues with your registration.

Name of Parent/Guardian (in the event of an emergency) *

Phone number for Parent/Guardian (in the event of an emergency) *

School Year *

Name of your School you attend or if you are a homeschooler *

Name of Town/City or Area you live in *

Region where you live *

If you would like to share any Social Media or Web Sites where we can see your art, please feel free to drop links here (Optional)

I would like to *

Attend a Live workshop event in my region
Attend a Live workshop event at my school
Join the Click Happy Plus Mentorship Program Online
Notify me of events in my Region
Subscribe to the magazine

You can select as many as you wish

Sign the Consent online or Upload your Consent Form? *

Sign Online
Upload Consent Form

Signature (signed by your parent or guardian if under the age of 16) *

Clear Signature

I give Click Happy employees, agents and successors the following rights: 1. to photograph, film, digitally record or video-record me and/or my child/ children; and 2. to make sound and voice recordings of me and/or my child/ children. These may be used now and in the future in any way that may be required. These reproductions or representations may appear as still camera photography and/or video images and/or digital images. Examples of uses include (but are not limited to) transmission in any manner and/or digital release, publication on the internet including social media, in promotional and educational material, in public exhibition or made available to our event collaborative partners (libraries, schools, and funders), both in New Zealand and overseas. Copyright, storing and ownership of the work will rest with Click Happy.

Upload Consent Form (signed by your parent or guardian if under the age of 16) *

Click or drag a file to this area to upload.

First download this Permission file and have your parent/guardian fill it in (Please do not email the Permission to us).
Once the Permission has been completed and signed by your parent's/guardian's, photograph/scan the Permission and upload it here 🙂

Wild Card Participants for Visual Poetry Jam

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