|
Young Voices of Loudoun County
Short Story Contest Entry Form
(Please Print)
Name: __________________________________________________________________
Address: ________________________________________________________________
Telephone: ______________________________________________________________
E-mail: _________________________________________________________________
School Name: ___________________________________________________________
School Address:__________________________________________________________
School Phone:___________________________________________________________
Grade: ___________________________ Teacher’s Name: ________________________
Category –Please Circle one.
High School Level Middle School Level Elementary School Level
Title of Entry ____________________________________________________________
Word Count: __________________
Waiver –(required for entry) I certify that my entry is my original work. I realize that contest judging is subjective by nature, and I may not be judged a winner or have my work selected for publication. In consideration of editor’s acceptance of my entry, I agree to indemnify, defend, and hold harmless, editor and all judges, sponsors and participants of the contest from liability for any actions arising from or related to judging and handling of my entry, as well conducting, sponsoring, and advertising this contest.
Student Signature: ____________________________ Date: _________________
Parent or Guardian Signature: ___________________ Date: _________________
A Completed Entry Form MUST Be Attached To Each Submission
|
