Young Voices of America Speak Up 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.   Grades 3-7               Grades 8-12                                 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