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: PO Box 1749
Koloa Hawaii 96756 USA
Thank you