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 of legal guardian sign at the bottom.  Staple
the completed form to the entry.


Student's Name:_________________________________________________


Home Address:  Street______________________________Apt. #_______
	
	       City________________________State_____Zip________


Teacher's Name:_________________________________________________


School Name:____________________________________________________

       District:________________________________________________

       Address: Street__________________________________________
     
	     	City_________________________State_____Zip______


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 of parent/legal guardian              Date