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BOOK ‘EM
FOUNDATION’S SECOND ANNUAL ART CONTEST ENTRY FORM
(type or print legibly)
Student’s Name
___________________________________________________________________
Mailing address
_________________________________________________________________
City/State/Zip
___________________________________________________________________
Grade in school year 2007/2008_________________
Title of
Illustration
_____________________________________________________________________
Book Title and
character or scene the illustration is based on
______________________________________________________________________________________
By entering the Book ‘Em Foundation’s
(BEF) Art Contest, I give permission for the BEF 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 understand the illustrations may not be
returned.
I
release the BEF, Waynesboro Police Department, sponsors and the
officers, directors, employees, licensees and successors from any
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 illustration for this
Contest.
Parent/Guardian
Signature
_____________________________email address______________________
Printed name _________________________________________________
Date _____________________
Mailing address
________________________________________________________________________
City/State/Zip ____________________________________________
Phone (____) __________________
Deadline for receipt of entries is:
October 1, 2007
Please send entries to: BEF Art
Contest
C/O Waynesboro Police Department
Attn: Officer Kearney
250 S. Wayne Ave., Suite 102, Box 3
Waynesboro,
VA 22980 |