Loving Kindness: A Children's & Teen's Art Exhibition about Mindfulness
Congratulations! The artwork created by your child or teen has been selected to be part of an art exhibition at Payne Art Gallery, on the Moravian University Campus in Bethlehem, Pennsylvania. The show will run from January 27-March 13, 2022.

We require a parent or guardian of each child or teen who is participating in the show to complete and sign this form.


If you have any questions about this form, please email Kristin Baxter, co-curator of the Mindfulness exhibition, at baxterk@moravian.edu 




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Name of child or teen *
Child or teen's school name and location *
Child or teen's age and grade level *
Parent/Guardian Full Name *
Parent/Guardian mailing address, including street address, city, state, zip *
Parent/Guardian Email Address *
Parent/Guardian Phone number *
By typing your name and date below, you are giving your permission for the following items:  1) My child’s artwork and my child’s signature, if visible in the artwork or photograph, may be published, republished, reproduced, edited, exhibited, used, or distributed by Payne Gallery at Moravian University in support of this exhibition.  2) Photos of my child’s artwork may be used by Payne Gallery at Moravian University in online promotions of the exhibition, and may appear in reports, presentations, publications, social media, webpages, or other media about or by the Payne Gallery of Moravian University. 3) I understand that if my child submitted a photograph of themselves (self-portrait) or someone else who they know (portrait), that they (or if minor, their parent or guardian) have given consent to show it in Payne Gallery’s exhibition, reports, presentations, publications, social media, webpages, or other media about or by the Payne Gallery of Moravian University. If you agree, please type your name and date below. *
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