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| How old are you?
___________ |
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| What is your first and
last name? _______________________________________________________ |
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| What is your parent's
first and last name? _______________________________________________ |
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| Where do you live? |
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| Address _____________________________________________________________________________________ |
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| City ___________________________________
State/Country ___________________ Zip Code ___________ |
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| What is your e-mail address?
_____________________________________________________________ |
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| What is your telephone
number? _________________________________________________________ |
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| What grade are you in?
____________ |
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| What is the name of your
school?_____________________________________________________________ |
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| What is the title of
your picture? _____________________________________________________________ |
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| What is your picture
about? ______________________________________________________________________ |
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| ________________________________________________________________________________________________ |
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________________________________________________________________________________________________
(If you need more room, please write on the back.) |
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All entries become the
property of Fly by Night Productions and may be
used by Fly by Night Productions in any
and all media now
known or hereafter developed for noncommercial
and commercial purposes alike. We will
contact the parent via phone to confirm permission.
(Please note: Original art work will not be returned)
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Parent/Guardian Signature
___________________________________________________________________
(Your parent or guardian must sign this sheet.) |
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| View our
privacy policy |