Massachusetts Teen Choice Book Award Logo Contest Entry Form

Name: ________________________ Birth Date:______
Address: _______________________________________
_______________________________________
School: _______________________________________

Artist Release

Statement 1:
The owners/copyright holders of this artwork grants permission to the Massachusetts Teen Choice Book Award to use the artwork in the following manner:
The Massachusetts Teen Choice Book Award may reproduce the artwork, whole or in part, in their displays, publications, web pages and presentations for an unlimited period of time. The Massachusetts Teen Choice Book Award will include artist credit in the identification material on the art and will endeavor to see that proper credit is given to the artist by all media.

I hereby waive my right to inspect and/or approve the finished product(s).
I affirm that the art submitted is original on my part and that I am sole owner of the material, and that neither the material nor the permission granted hereby infringes upon the rights of others.

I understand the artwork will not be returned.

Signed: _________________________________________________________

Print name: ______________________________________________________

Date: ___________________________________________________________

Statement 2: Participation of Minors

The signature of a parent or legal guardian is required for participation. I hereby give my
permission for the participation of the named minor in the art contest. I read and agreed to Statement 1.

Name of Minor: __________________________________________________

Signature of Minor: _______________________________________________

Parent/Guardian’s Name: ___________________________________________

Parent/Guardian’s Signature: ________________________________________

Relationship to Minor: _____________________________________________