Participant Consent Form « Pathway to miyo-pimâtisiwin Network

Download Printable PDF View Gallery Info Sheet Contest Consent Form

Are you interested in having your artwork displayed on the Virtual Art Gallery?

If you are interested in submitting any of your artwork or stories/poems to the virtual gallery, fill out this consent form. If you are entering one of the contests, be sure to fill out the contest sectionat the bottom. Once this form is filled out, please call your local John Howard Society institutional support lineand we will arrange for your artwork to be picked up:

John Howard Society of Saskatchewan’s institutional line: 1-833-779-2115

Artwork will be safely stored by Pathway to miýo-pimâtisiwin and can be returned to family members upon request or held until release.

Please note: Submissions that don’tcome with a properly filled out participant consent form cannot be accepted.

Artist Info
Artist Name*
First Last
Current Institutional Facility*
Do you wish to be acknowledged by your given name with your artwork?*
- No - Anonymous submission
- Yes - Enter name to display
Display Name*
Artwork Title*
Contact Person (optional)
Contact information for a friend or family member of the artist. A copy of this form submission will be sent to the email address below if specified.
Contact Person Name
Contact Email
Contact Phone
Is the contact person able to collect the artwork?
- Yes
- No - someone else will need to collect it
- No - it will be submitted digitally or via mail
What else should I know?
People love stories and to know the person behind their artwork. Knowing this, we would love to give you the opportunity to share additional information relevant to you and your artwork. Please include additional pages if need be. Some ideas of what to include with your artwork:
- How you got started
- What inspires you
- Reason behind the materials or techniques used to create a particular piece of art
- What a particular piece means to you
- Information about the artwork
About the Artist
Personal story or information for an “about the artist” section (optional).
About the Artwork
Artwork description or story to be displayed with art (optional).
Consent*
By checking below, I agree to the following:

1. I hereby grant permission to Pathway to Pimachisowin to upload my artwork to be virtually displayed on an online gallery platform for public display.

2. I understand that my artwork is being posted online and the copying of this art is prohibited. I understand Pathway to Pimachisowin is not liable for lost or copied art as this is the unavoidable risk of an online gallery.
I have read and understand the terms above.
Artist Signature*
Name
This field is for validation purposes and should be left unchanged.

Participant Consent Form

Are you interested in having your artwork displayed on the Virtual Art Gallery?

Artist Info

Contact Person (optional)

What else should I know?