Complete this Entry Form and correctly solve the Cyberchase mystery. After you have answered the mystery, have your parent or legal guardian read and sign the form. We can't accept your entry unless you have their permission and signatures. (You must be under the age of 16 to enter.) The completed Entry Form must include your written answer to the mystery, and all parental/legal guardian signature and information pages. Remember-- the Entry Form must be postmarked by November 4th. 2005. Mail the completed Entry Form to: THE 2005 CYBERCHASE ONLINE CONTEST P.O. Box 1313 JAF Station New York, NY 10116 Have your parent or legal guardian read The 2005 CYBERCHASE Online Contest official Rules. To review the PBS Privacy Policy, go to http://pbskids.org/privacy/. By signing below, I hereby represent that I am the parent/legal guardian of the child named above, and I hereby grant permission for him/her to participate in The 2005 CYBERCHASE Online Contest and to use my child's first name and to indicate the city and state in which he/she resides on the CYBERCHASE Web site (www.pbskidsgo.org/cyberchase) if he/she is selected as a winner. I also hereby grant permission to provide my child's first and last name to the child's school or community education group if selected as the Grand Prize winner. (CYBERCHASE will not use or distribute any other personal information, and all gathered information will be destroyed after the completion of this Contest.) _________________________________ Parent/Legal Guardian's signature _________________________________________________ Print Parent/Legal Guardian's first and last name Parent/Legal Guardian's address: _______________________________________ __________________________________________________________________ Street, City, State, Zip Code (No PO boxes please) Please provide a phone number and e-mail address (if available) at which to notify you if your child wins. Phone number: ________________________________________ E-mail address: ________________________________________ How did your child hear about The 2005 CYBERCHASE Online Contest? (Check all that apply.) ____ On the Cyberchase web site ____ On the local PBS station web site ____ From my local PBS station (other than web site) ____ From another web site (which one) ______________ ____ In a newspaper, magazine or other print media ____ From a friend or family member ____ At school, public library or after-school group (please specify) ______________ ____ Other (please specify) ___________________________ Does your child attend a public, parochial or private school? _________ Is your child home schooled? _____________ Parent/Legal Guardian: If your child is a winner in the Grand or First Prize categories in The 2005 CYBERCHASE Online Contest, may we provide your name, address and phone number to your local PBS television station so that you can be contacted about possible local press coverage regarding The 2005 CYBERCHASE Online Contest? _____ Yes _____ No What is the name, city and state of the PBS station(s) where you watch CYBERCHASE? (If you watch CYBERCHASE on more than one station, please list all.) _________________________________________________________ ______________________________________ Parent/Legal Guardian's signature ______________________________________ Print Parent/Legal Guardian's first and last name Parents, would you like to receive regular e-updates about CYBERCHASE programming or merchandise? If so, please provide YOUR (NOT your child's) e-mail address, which constitutes your permission: ______________________________________ Please review the complete The 2005 CYBERCHASE Contest Rules. To review the PBS Privacy Policy, go to: http://pbskids.org/privacy/.