Kids In Space

ENTRY FORM:

Please type or print legibly in black ink all information. Enter student's name as they wish it to be sent into space. Please have the student's parent or legal guardian sign at the bottom. Staple the completed form to the entry.

Student's Name:_________________________________________________

Home Address: Street______________________________Apt. #_______

Teacher's Name:_________________________________________________

School Name:____________________________________________________

Grade:__________

Age:____________

I certify that the work that I am submitting to the KIS program is an original composition or piece of artwork, i.e. it has not been copied from another source. I understand that my entry cannot be returned to me once it has been submitted to Kids In Space.

Signature_____________________________________________Date_______

I, ___________________, parent/legal guardian of ____________________, verify that my child's submission is an original piece of literary and/or art work which he/she created individually. I will permit the publication of my child's submission, if selected, on the World Wide Web and in a NASA publication, from which I understand there will be no royalties. I also understand that there is no guarantee that my child's submission will be published in a NASA publication.

Signature_____________________________________________Date_______