I wanna be a La JaJa Kids Junior Journalist
Complete this form and send to La JaJa kids by fax or e-mail
Fax (323)346-0160; Scan and E-mail to email@example.com
Student Full Name ______________________________________________________________________________
Birth date (month/day/year) _______/_______/___________ Age __________ Gender _______________________
School Name ___________________________________________________ Grade ________________________
Home Phone (__________)_____________________________ Cell Phone (_________)______________________
In a separate sheet of paper, write a short paragraph (less than 100 words) about “Why should YOU be chosen as a Junior Journalist?”
You may write in English or Chinese
Requirements and Rules:
• Must be a current third, fourth or fifth grade student
• Write a short paragraph about why you should be a Junior Journalist
Parental Consent Form
Complete this form and send to La JaJa kids fax (323)346-0160 or scan and e-mail firstname.lastname@example.org
I have carefully considered the activity and have given consent for myself or my child to perform the duties of Junior Journalist for La JaJa Kids, and participate in the activities listed above. I understand that participation in the activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.
I understand that my child will be obligated to attend the interview and the premiere at the indicated dates and locations. I will provide the transportation needed for my child to attend these events on time. I understand that my child is responsible for her/his behavior at all time, and agree not to hold the school or any of its employees responsible for any expenses or damages incurred as a result of my child’s behavior. I also understand that any violation of the school’s code of discipline may result in exclusion from the team.
I hereby give permission for my child’s photograph, artwork, poetry or other work produced in conjunction with this activity to be put on the World Wide Web (WWW) site. I understand that the information to be posted does not include information from my child’s academic, guidance, permanent or cumulative record (i.e. grades or attendance records). I also understand that the information to be posted does not include other personal identifiable information such as my child’s address, phone number, or social security number. I also understand that La JaJa Kids holds the copyrights of all the published writings and photographs produced by the junior journalists.
I hereby give permission for my child to be interviewed and/or photographed by the media as it pertains to his/her Junior Journalist duties. I also hereby release La JaJa Kids , and its agents and employees, from all claims, demands, liabilities whatsoever in connections with the above.
Student name __________________________________________________
Parent/guardian printed name ______________________________________
Parent/guardian signature _________________________________________
For Information, call 323.728.7200 or e-mail email@example.com