St. Eugene Respect Life Essay Contest Entry Form

Title of Essay:  _______________________________________________ 

Student Name:  ______________________________________________ 

Street Address:  _____________________________________________ 

City:  _______________________________       Zip: _________________

Telephone:   __________________________       Grade:   _____________

Parent or Guardian Name:   ______________________________________

Student Consent:
I acknowledge that I have read and accepted the rules of the contest.  I certify that the writing submitted is my own original work.  If I am a winner, I give permission to St. Eugene to publish my essay including my name and grade.

Student Signature:   ____________________________________________

Parent Consent:
I acknowledge that I have read and accepted the rules of the contest.  I certify that I am the parent or guardian of the student submitting this essay and that the student has my permission to enter the contest.  If this entry is a winner, I give permission to St. Eugene to publish this essay including the student’s name and grade.

Parent Signature:   _____________________________________________

Internal use only: ID #: _______                                                                                1/22/11