Kids Public Radio Release Form

Kids Public Radio

Release Form

Your name:

Your address:

Your phone:

Your contact phone, publishable on the web, if different (800 number, etc):

Your email:

Your website URL:

ASCAP? BMI? SOCAN?

I hereby give the Kids Public Radio, Jabberwocky, Lullaby, and Pickleberry Pie Inc., permission to use portions of my wholly-owned recordings, audio productions, artwork, and/or written comments ( list here)

on its website and in broadcast for public information purposes. I certify that I am the copyright owner of these recordings. I retain all rights to this material.

_________________________

your signature

______________
date

If under 18, please have parent sign permission here and date.

__________________________

Parent signature

______________________

date

Send to: 305 Dickens Way Santa Cruz, CA 95064 USA Thank you