Penguin Random House Request Form

Request permission to use Penguin Random House materials for your program

All requests should be submitted at least 60 days prior to the intended usage.

Local Imagination Library Partners may request permission to use select Penguin Random House materials—such as cover art or Live Read-Aloud content—for specific, one-time uses. A Permission Request Form/Agreement must be completed and submitted for each individual request. All forms will be reviewed by Penguin Random House LLC prior to approval.

Are you a Dolly Parton's Imagination Library Program Partner?(Required)

Yes

This request is exclusively for our program partners.
If you're interested in becoming a partner and discovering the many advantages, please visit our website to learn how to join us:
https://imaginationlibrary.com/usa/start-a-program/

Organization Name(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Program Partner ID (Example: TNSEVIER)(Required)

Regional Team Member(Required)

Contact Person(Required)

First Last

Phone #(Required)

Email(Required)

Enter Email Confirm Email

Is the organization a qualified US tax-exempt charity or educational organization per Internal Revenue Code Section 501(c)3?(Required)

Yes

Is the use for a fundraising event, campaign or appeal for Dolly Parton's Imagination Library?(Required)

Yes

Permission Usage Requested(Required)

Book Cover Image

Read Aloud

Story Walk (Story Book Trail)

Other

Book Cover Image

Start date of usage(Required)

End date of usage(Required)

How will the material be used?(Required)

Explain how material will be used(Required)

Please attach a sample of the intended usage(Required)

Drop files here or

Max. file size: 150 MB, Max. files: 3.

Please choose an approved title from the list below.(Required)

Cover Image approval(Required)

Cover Image approval is granted solely for the front cover image of the Book and must not be altered in any way.

Language(Required)

English

Bilingual (English/Spanish)

Request could not be proceeed. Cover image alterations are not able to be approved. Ptease direct follow up questions to your Regional Director.

Permission Agreement For Print Use Of
Book Cover Image For Non-Profit Promotion Of Dolly Parton’s Imagination Library Literary Project And The Book

Title: THE LITTLE ENGINE THAT COULD: 90th Anniversary Edition by Watty Piper, illustrated by Dan Santat.

Title: THE LITTLE ENGINE THAT COULD: 90th Anniversary Edition / La pequeña locomotora que sí pudo: Edición del 90º Aniversario by Watty Piper, illustrated by Dan Santat.

Title: autofill

Penguin Random House LLC (“Publisher”), grants the non-profit organization (the “Non-Profit Organization”) named in the Permission Request Form non-transferable permission on a one-time, non-commercial, non-profit and non-exclusive basis for use of the Material from the Book as provided below:

Material: Front cover image of Book

Authorized Use: Specified in attached Permission Request Form

Term:

Territory: USA

Language:

Permission Fee: No charge

CREDIT LINE must be included on all uses of the Material:
From the book THE LITTLE ENGINE THAT COULD: 90th Anniversary Edition by Watty Piper, illustrated by Dan Santat. THE LITTLE ENGINE THAT COULD: 90th Anniversary Edition / La pequeña locomotora que sí pudo: Edición del 90º Aniversario by Watty Piper, illustrated by Dan Santat. and illustrator © Published by Penguin Young Readers Group, a division of Penguin Random House LLC. The Little Engine That Could, I Think I Can and all related titles, logos and characters are trademarks of Penguin Young Readers Group, a division of Penguin Random House LLC. All rights reserved. Used with permission. , a division of Penguin Random House LLC. Used by permission.

Required Terms of Use:

The Material shall be used only for promotion of the Book and Dolly Parton’s Imagination Library literacy project in accordance with the Authorized Use.
This permission shall cover only the use of the front cover image of the Book intact and without alteration in print media or for use in a non-downloadable website posting to promote the Authorized Use. Except as provided in the foregoing sentence, no other digital or online use of the Materials shall be permitted.
The Material shall not be used in any manner which may be considered derogatory to the Book, its content, its author/illustrator, Publisher, or the Dolly Parton Imagination Library, bearing in mind that the Book is for young children.
No merchandise shall be created, distributed, given away or sold using the Material or any portion of the Material or the Book’s text, artwork, characters, trademarks or other elements, the names or likenesses of the author and/or illustrator, or the Penguin name or logo.
All expenses of the Authorized Use shall be borne by the Non-Profit Organization.
The Non-Profit Organization shall not dispute or contest directly or indirectly the Publisher’s, author’s or illustrator’s rights in the Book and shall not assist or aid others in doing so.
The Non-Profit Organization shall indemnify Publisher, the Book’s author and illustrator and Dollywood Foundation for any damages, claims, liabilities, judgments (and related attorneys fees) arising out of its use of the Material.

Read Aloud

Start date of usage(Required)

End date of usage(Required)

Will this Read Aloud be recorded/live streamed/broadcast?(Required)

Name of Organization Requesting(Required)

Street Address of Requestor(Required)

Please choose an approved title from the list below.(Required)

Purpose for recording(s)(Required)

Website(s) address where recordings will be posted(Required)

Are website(s) private?(Required)

Yes

Do they require a secure login for access?(Required)

Yes

Are they publicly accessible?(Required)

Yes

Is Youtube used as a hosting platform for these videos?(Required)

Yes

Please note that videos must not be downloadable. (Agree?)(Required)

Yes

Story Walk (Story Book Trail)

Start date of usage(Required)

End date of usage(Required)

Please choose an approved title from the list below.(Required)

Other

Purpose for uses(s)

Please add a precise and detailed explanation

Please choose an approved title from the list below.(Required)

Agreed and accepted:

Name(Required)

Signature(Required)

Enter full name just like above

Date(Required)