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contest entry form

Page history last edited by michianawriterscenter@... 12 years, 6 months ago

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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