Registration Information: Parents, please fill out this registration form completely and submit on-line or mail it to the address listed below. By completing the registration form, parents grant Portledge School and the Theodore Roosevelt Sanctuary & Audubon Center the use of your child’s photograph/videograph for public information and promotional purposes related to attracting and promoting Portledge School and the Theodore Roosevelt Sanctuary & Audubon Center.  I understand that I will not necessarily be informed about each such use of my child’s image. Sending registration forms by mail: Create Something Great Recycled Sculpture Contest Portledge Lower School 355 Duck Pond Road Locust Valley, NY 11560 Registration forms must be received no later than Friday, March 16, 2012. Receipt of the registration form by the deadline is vital so that we may properly plan for the display and exhibition of the recycled sculptures.

	Registration Form
	Contact Information *Child's First Name: *Child's Last Name: Current Grade Level: School: Town: Parent's Full Name: *Email Address: Day time phone number: Name of Animal Sculpture: List some of the recycled materials used in creating this sculpture: Number of guests attending on March 31th? Children Adults How did you hear about this contest?  School  Postcard  Newspaper  Library  Other