TREEHOUSE TALES 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 Treehouse Tales Young Writers and Illustrator's Contest , I give permission for WCNY-TV 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 that stories may not be returned.
I release WCNY-TV, 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 April 13, 2007
Send To:
WCNY-TV/FM
Educational Services
506 Old Liverpool Rd.
PO Box 2400
Syracuse, NY 13220-2400
ATTN: Treehouse Tales