Short Story Student Consent Form

Short Short-Storytelling Contest

Student Entry Form

This form must be completed and signed by each student contestant.

Student Name: ____________________________________________________
Age: _________

Name of School: ___________________________________________________
Class (Please circle): Junior    OR    Senior

Email Address: _____________________________________________________
Phone Number: ____________________________________________________
Address (City, State, Zip): _____________________________________________

I am currently enrolled at the above named school and wish to enter the WKMS Short Short-Storytelling Contest. It is my understanding that I am submitting a 3 to 5 minute audio recording and text version of my original short story. If chosen as a finalist, I will read my story in the contest finals on Tuesday, October 30^th at Murray State University. I hereby consent for WKMS-FM to broadcast my recording and/or post my story to wkms.org. And for Paducah Life Magazine to print my story if I am the winner. I also consent to WKMS-FM or Paducah Life to publish my photo to local newspapers and/or on their websites for publicity if I win. If I am not 18 years old, my parent or guardian gives their consent by signing below.

____________________________________            ____________________

Signature of Student                                                            Date

_______________________________________           ______________________

Signature of Parent                                                              Date