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PBS GO Writers Contest
ENTRY FORM (type or print legibly) Child's Name______________________________________________________Age____________ Circle Grade: Kindergarten 1st Grade 2nd Grade 3rd Grade Sex: F M Title of Story_____________________________________________________________________ By entering the PBS GO Writers Contest, I give permission for PBS to use this work, which will be credited to the entrant/author, as it wishes, including (but not limited to) display, promotion, reproduction and distribution in all media and the right to create, perform, display and distribute derivative works. I also give them the right to use the entrant/author's name, likeness and biographical material in connection with the work. I release PBS,
their parent companies, sponsors, and the officers, directors, employees,
licensees & successors from any liability or claimed liability in
connection with this Contest submission. I
acknowledge that I have read this consent & release prior to signing
it & that I understand its contents. I warrant that this child alone
has created the story text and illustrations for this Contest. Printed Name____________________________________________ Date___________________ If different than
child's address above: City/State/Zip_____________________________________ Phone (____)____________________ If this is a school-related entry, the following must be completed: Signature of Teacher_______________________________________________________________ Printed Name____________________________________________________________________ School Name____________________________________________________________________ Deadline for receipt
of entries is March 23, 2009. |