This video contest is for teen aged youth (ages 12 – 17 –or- school grades 6th thru 12th) and may be used in a large scale media contest and awareness campaign to prevent underage drinking. All aspects of this contest entry will be conducted on-line. Completion of a survey by the video’s youth is REQUIRED for entry. This survey is done both BEFORE (Part 1) and AFTER (Part 2) creating a video. All (*) marked items are required to enter:
Signature Page. After you have completed this entry form below, please sign it. After printing it, both the lead youth and the adult sponsor must sign above their digital signatures. This should then be scanned and emailed to jengle@sevencounties.org.
(If anyone forgets to print before submitting their on-line entry form and uploading their video, they can still submit a signature page by going back to the entry form page, printing a blank entry form (do not fill out a duplicate on-line entry form!), fill in the name of the video (as it was listed on the on-line form), the lead youth and adult sponsor names and sign it. It can be scanned and emailed to jengle@sevencounties.org. No scanner? No problem… you can mail proof (postmarked on or before January 17th 2012) to REEL ACTION address listed below.)
Video. *Upload :28 second video after completing the on-line entry form.
Note: Several types/qualities of videos (Movie Maker, Windows Media, etc. files ending in .wmv, .mov, avi, .m4v) should upload. However, only those in file format H.264 (higher definition/resolution) standard will meet the threshold of most major media outlets (such as Movie Cinemas, TV, etc.) for air time conversion. Any videos not in High Definition or High Resolution can still enter the contest and be eligible for prizes/recognition. However, if they do not meet the media outlet threshold for conversion – REEL ACTION can not guarantee mass media distribution. Not familiar with QuickTime H.264? Don’t worry! Step-by-step directions will guide you through the upload process. Still unsure? Here’s a tutorial.
NOTE: Due to multiple entries with similar/same video and/or participant names; we strongly suggest listing the lead youth’s LAST name as part of the video file name so it can be more easily linked to the entry form and video title. Finally, we also suggest that video titles are specific and unique (each year, several videos named “underage drinking” (or similar) have been submitted leading to confusion in matching videos with their proper creators).
If you have all of your forms together and ready, it should take approximately 10 minutes to complete this form, both surveys and upload your video and email any other forms needed. Please read this entire form in advance to make sure you have all items and tools needed to submit your entry on time!
Video file name MUST match the video title listed on entry form.
Any that do not, cannot be matched to entry for and therefore, cannot be entered.
Lead Youth Information*
First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Age of Youth:
Home Phone:
Cell/Other Phone: (NOT REQUIRED)
Youth Email Address: (Email or text through, at least, June 2012)
Parent/Guardian Name:
Parent/Guardian Email:
Parent/Guardian Cell:
Can youth get Text Updates via cell?**
Yes No
If yes, phone carrier?
Can parent get Text Updates via cell?**
Yes No
If yes, phone carrier?
**While there is no charge for text messages from this contest, any recipient’s carrier rates apply.
School or Community Center Information*
School or Community Center Name:
Street Address:
City:
State:
Zip Code:
Phone (including area code)
Email Address: (Email or text through, at least, June 2012)
Check here if youth did project without the help of a school or community group. If so, mark n/a in each of the categories for this section. Without school/community group help, Sponsoring Adult should be youth’s parent/guardian/care provider.
Sponsoring Adult Information*
(an adult must ‘sponsor’ the youth’s entry submission
– see ‘Contest Rules’ for details)
First Name:
Last Name:
Relation to Youth:
Street Address:
City:
State:
Zip Code:
Phone (including area code)
Cell/Other Phone:
Email Address: (Email or text through, at least, June 2012)
Not counting the lead youth; how many youth, total, helped or was involved in a SIGNIFICANT way, with your video?
Beyond that, how many additional youth, helped in ANY way?
Not counting the adult sponsor; how many adults, total, helped or was involved in a SIGNIFICANT way, with your video?
Beyond that, how many additional adults, helped in ANY way?
SIGNIFICANT Others Involved, if any:
Name(s)
Youth
or Adult?
Email
Cell
(area code)
Okay to receive text messages via cell?
If yes, which carrier?
Releases of Information*
*Please check a box to the right to indicate your preference regarding use of lead youth entrant’s name and/or likeness for public use. This can include any airings of video(s) and/or photos at and/or videotaping of video ceremony (such as, but not limited to: media airplay, meetings, movie screens, websites/internet, etc.).
Full Name & School/organization
First Name only (no last name) & School/organization
No name listed – only List school/organization
*By clicking this box, I state I have read and understood and complied with Copyright Rules. Copyrighted, materials (including popular songs/music) are NOT PERMITTED without written and verifiable proof of permission (including video title, lead youth and adult sponsor names, copyrighted/trademarked/protected material title and authorization authority and signature of authorized agent granting permission. Written proof due at time of entry can scanned and emailed to: jengle@sevencounties.org. No scanner? No problem… you can mail proof (postmarked on or before January 17th 2011) to REEL ACTION address listed below.
*By clicking this box, I state that I have read, understood and complied with this entry form as well as all Contest Rules.
*By clicking this box, I state that this form and video entry has been completed with the knowledge and consent of the Adult Sponsor as well as Lead Youth
*By clicking this box, I state that I understand this contest is part of a public media awareness campaign and that videos submitted, as well as pictures taken at and/or videotaping of myself during the Awards Ceremony, become the property of Seven Counties Services, Inc. and may be included in said public media awareness campaign, promotion and outreach.
Signatures*
*Youth Digital Signature
*Adult Digital Sponsor Signature
*Date
*Click the Print Form and Upload Button to right to print completed form. Lead Youth and Adult Sponsor must sign above digital signatures on printed copy. Signed form can be scanned and emailed to jengle@sevencounties.org. If a scanner is not available, completed signed form with original signatures can be mailed (postmarked on or before January 17th 2012) to address listed below.
No scanner? Mailing address:
REEL ACTION Prevention of Underage Drinking Contest
c/o Jackie Engle, Prevention Specialist
Seven Counties Services, Inc.
101 W. Muhammad Ali Blvd.
Louisville KY 40202.
