Official Entry Form-- Please Print
2011-2012 K-12 Doodle Your Heart Out Writing Contest
Title of Entry:_________________________________________
Author’s name:_________________________________
Parent/Guardian name(s):_____________________________________________
Grade:__________ Teacher:________________________________________
Teacher’s email: ________________________________
School:______________________________________
School address:_________________________________________________
______________________________________________________________
(city) (state) (zip code)
School phone:_(_____)________________
To be completed by author’s parent/guardian:
please check all that apply and sign below. Entry is not valid until signed.
□ I hereby give my child permission to participate in the K-12 Doodle Your Heart Out Writing Contest.
□ I hereby give the International Reading Association permission to photograph my child and use those
photographs in releases and promotional materials, as they deem appropriate. Children will be
identified by first name only in photographs.
□ I hereby give the International Reading Association permission to release my child’s name, if chosen
as a winner, in press releases to area newspapers.
□ I hereby give the International Reading Association permission to publish and distribute my child’s
work, if chosen, in local newspapers and on the IRA website.
□ I hereby give the International Reading Association permission to use my child’s work for
instructional purposes.
Signed: _____________________________________________ Dated:_______________________
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