Clone of Practicing Artists Application

1
Full Name* This field is required.
First Name
Middle Name
Last Name
2
Full Name and optional Preferred Name* This field is required.
3
City / Region* This field is required.
4
Email* This field is required.
example@example.com
5
Phone Number* This field is required.
Please enter a valid phone number.
6
Website / Portfolio
7
Social Media & Website / PortfolioPlease include any social media profiles and/or website URLs that you would like to have highlighted (for example: facebook.com/artist-name, instagram.com/artist-name, artistname.com)
Huge
Large
Normal
Small
Ok
Ok
8
Social MediaPlease include your social media handles and website URL below (Instagram, Facebook, X, etc.)
9
Payment is required before continuing your application* This field is required.
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My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costCAD
Artist Index Listing
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Gallery Member Artist
Gallery Member Artist
Non Member Artist
Membership Status
Total cost
Debit or Credit Card
10
Would you like to continue your application online or have us reach out to coordinate in-gallery support?
Continue Online
In-Gallery Support
11
Career Biography - Maximum 500 words* This field is required.
12
Artist Statement - Maximum 300 words* This field is required.
13
Image Submission Files* This field is required.Upload your images here (up to 24 MAX), then fill in the details for each one below
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Upload a File
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14
Inventory List of Works* This field is required.For each piece please note the Title, Medium, Date, an optional note or description, and the associated file name(s)
15
Number of Works Submitted - Maximum 24 images* This field is required.
16
Inventory List of Works - Title, medium, year required* This field is required.
17
Copyright & Ownership Declaration* This field is required.
I confirm that I am the creator of all submitted works or have full legal rights to submit them, and I retain copyright of my works unless otherwise stated in writing.
18
Permissions* This field is required.
Digitally archive submitted materials
Display materials on the Artist Index platform
Use materials for non-commercial educational, archival, and promotional purposes related to the Index
19
Withdrawal Clause Acknowledgement* This field is required.
I understand that I may request the entire removal of my Artist Index website page in writing to art@kawarthagallery.com, and that no refunds will be given for removal of any Artist Index website page posting.
20
Disclaimer & Indemnity Acknowledgement* This field is required.
I acknowledge that the Kawartha Art Gallery is not responsible for loss, misuse, or misrepresentation of uploaded materials beyond reasonable archival care, and I indemnify and hold harmless the Gallery, its staff, and affiliates against any related claims.
21
Gallery Discretion Acknowledgement* This field is required.
I understand that the Gallery may remove or refuse any submission at its discretion.
22
Privacy Notice Acknowledgement* This field is required.
I understand that my personal information will be used solely for administration of the Artist Index program and will not be sold or shared outside of program purposes.
23
Image and text updates
I wish to be contacted by the Gallery in two years time from the date of my first Artist Index uploading for image and text updates of my page and understand that all updates are fee based.
24
Confirmation of Agreement* This field is required.
I agree that all confirmations made by me in this application are accurate and true, and I agree with and will abide by the terms of this Application.
25
Digital Signature* This field is required.
26
Date* This field is required.
Date
Month
Day
Year
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