intro Thank you for helping to document the COVID-19 pandemic in Madison. This is the form to fill out to share an image and a written response to it. The image should be something that relates to your experience of the COVID-19 pandemic, while schools and many businesses are closed, and while we are social-distancing. The written response can be about the image - a poem, a song, a caption, a few sentences, or a longer piece. Image Upload an Image * Files must be less than 5 MB.Allowed file types: gif jpg jpeg png. Title of Image * Name of Artist / Photographer * Age of Artist / Photographer * Response How do you want to add your written response? * - Select -Type my response hereUpload a file Written Response - Type It * Written Response - Upload * Files must be less than 5 MB.Allowed file types: gif jpg jpeg png txt rtf pdf doc docx odt. Name of Writer (if different from artist / photographer) Age of Writer (if different from artist / photographer) Parent / Legal Guardian InfoBecause either the artist or writer is younger than 18, a parent/legal guardian needs to grant permission and verify with an email address. Parent / Legal Guardian Name * First and Last Name Parent / Legal Guardian Email * Comments / Contact Comments / Instructions Email Address * Library staff will be in touch via email if there are questions about your submission. Additional Communication Would you like to updates or additional information about the Madison Living History Project? Send me emails related to the Madison Living History Project. Agreement Public / Anonymous * Please select an option. You can publish my material with my name attached. I would prefer to publish my material anonymously. Agreement * By checking this box, I grant Madison Public Library permission to publish and distribute my material in the "Stories from a Distance" archive, and in promotional materials including but not limited to, Madison Public Library's websites, the City of Madison's websites, local media outlets, and the library's social media platforms. disclaimer Thank you for sharing your story! Please complete the form by clicking "Submit" below. Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
