Philipse Manor Hall State Historic Site
Student Art Contest Submission Form

2007 Theme: All posters must focus on the Philipse Manor Hall exhibit: Slavery: The Great and Foul Stain.

All submission forms and posters must be submitted by 5:00 p.m. on Wednesday, January 31, 2007 to:

Philipse Manor Hall State Historic Site
29 Warburton Ave.
Yonkers, NY 10701

Please do not attach this form to the poster in any way.

Student Information:

Last Name: _____________________________  First Name: ____________________________

Address: ______________________________________________________________________

City: __________________________________  Zip Code: _____________________________

Telephone: ________________________  Age: ______________  Grade: _________________

School: _______________________________________________________________________

Teacher's Name: _______________________________________________________________

Parent/Guardian Signature:

Authorizes student to enter the poster contest and accepts rules and deadlines for contest.

Parent/Guardian Name (printed): ___________________________________________________

Parent/Guardian Signature (script): _________________________________________________

Date: ___________________________