READING RAINBOW’S YOUNG WRITERS AND ILLUSTRATORS CONTEST
ENTRY FORM
(type or print legibly)
Child’s Name
__________________________________________________________Age____________
Child’s Mailing
Address________________________________________________________________
City/State/Zip___________________________________
Home Phone
(_____)_________________
Circle Grade:
Kindergarten
1st Grade
2nd Grade
3rd Grade Sex:
F M
Title of Story_________________________________________________________________________
Number
of Words ______________
Grades K-1 min of 50- max of 200 words;
(The
word count includes “a,” “an,” & “the.”)
Grades 2-3 min of 100- max of 350 words
Number of
Illustrations ____________
(minimum of 5)
By entering the Reading
Rainbow’s Young Writers and Illustrator’s Contest, I
give permission to use this work, which will be credited
to the entrant/author,
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 the right to use
the entrant/author’s name, likeness and biographical material
in connection
with the work. I understand that
stories may not be returned.
I release GPN/WNED,
their parent companies, sponsors, and the officers, directors, employees,
licensees and successors from any liability
or claimed liability in connection
with this Contest submission.
I acknowledge that I
have read this consent and release prior to signing it and that I understand its
contents.
I warrant that this
child alone has created the story text and illustrations for this Contest.
Parent/Guardian
Signature ______________________________ Email address: __________________
Printed
Name_____________________________________________________
Date___________________
If different than
child’s address above:
Mailing Address
__________________________________________________________________________
City/State/Zip_____________________________________________
Phone (____)____________________
School-related entry:
Teacher Signature ___________________________________ Email address:
________________________
Printed
Name_____________________________________________________________________________
School
Name_____________________________________________________________________________
School Mailing Address____________________________________________________________________
City/State/Zip
____________________________________________ School Phone (____)_______________
Deadline for receipt of entries and
Reading Rainbow is a
trademark of of GPN/NET Nebraska and WNED-TV,