THE TEEN SAFE DRIVING/ANTI-BULLYING POETRY/ART/VIDEO CONTEST
ENTRY FORM
Student Information (To be completed and signed by student’s parent or guardian)
Student’s Name:__________________________________________________________________
Address:________________________________________________________________________
City______________________________ State:____________________ Zip:_________________
Grade:____________________________ Birth date:_____________________________________
Student email:___________________________________________________________________
School / Organization Name:________________________________________________________
School/Organization Address:_______________________________________________________
Parent/Guardian Name:____________________________________________________________
Parent Email:____________________________________________________________________
Parent Phone No. :________________________________________________________________
Parent’s Signature:________________________________________________________________
Date:___________________________________________________________________________
All submissions must be received by February 14, 2014. Mail submissions to:
Ryan Cameron Foundation
Attn: Youth Anti-Violence Contest
P.O. Box 550469
Atlanta, GA 30355
The Teen Safe Driving/Anti-Bullying Essay/Poetry/Art/Video Contest Guidelines
NO PURCHASE IS NECESSARY TO ENTER OR WIN.
The Teen Safe Driving/Anti-Bullying Essay/Poetry/Art/Video Contest is presented by the Ryan
Cameron Foundation in partnership with The Allstate Foundation (the “Sponsor”). Participants will
write an poem, or create a piece of artwork (painting, drawing or collage), or create a sixty (60)
second DVD, offering a message on reducing bullying or unsafe, distracted or reckless teen driving.
Topics need to relate to TEEN SAFE DRIVING or BULLYING. The participants can draw from
personal or peer experience(s). The purpose of this contest is to strengthen participants’ ability to
express and engage and invoke a sense of ownership in resolving these youth issues.
Submissions are due by 11:59 PM ET February 14, 2014.
Submissions are due by February 14, 2014 and should include:
-
Completed Entry Form
-
Signed Release and Waiver
-
Typed Poem, or Artwork (painting, drawing or collage), or DVD.
Please Note:
-
Limit one (1) submission per student allowed.
-
Late and/or incomplete submissions are ineligible for the Contest.
-
Group submissions will only be allowed for Video category. If a group video
submission wins, then the prize money must be shared equally amongst the group
members.
RULES
NO PURCHASE NECESSARY. The contest is open to youth who are legal residents of Georgia
between the ages of 8 and 19 as of February 14, 2014. Past winners are not eligible to submit
again until 12 months following their last winning entry. Participants must be currently enrolled in a
public, private, charter or home school.
Subject to additional terms and conditions in the Official Rules.
Submissions will be evaluated on creativity/originality; overall content; and depth of the proposed
solution(s). The decisions of the judges will be final and binding.
There will be one (1) winner in Grades 3 - 5. The winner will receive $50. The class of the winning
student will receive a pizza party. The teacher of the winning student will receive a $25 gift card.
There will be nine (9) winners in Grades 6 - 12. Prizes for the winners are: Three (3) 1st place $300; Three (3) 2nd place - $200 and Three (3) 3rd place - $100. Total Approximate Retail Value of
all prizes: $1,875. Void where prohibited. Submissions must include all entry requirements
including parent or legal guardian signatures.
RELEASE AND WAIVER OF CLAIMS (MINOR-UNDER 18)
As the parent or legal guardian of the underage (the “Minor”), and on behalf of the Minor, I hereby
give permission for the Minor to participate in certain promotional activities of The Allstate
Foundation and/or Ryan Cameron Foundation (the “Co-Sponsors”) including activities surrounding
the (the “Contest”) and additional future events and activities of the Co-Sponsors. I HEREBY
ACKNOWLEDGE AND AGREE THAT PARTICIPATION IN THE AFOREMENTIONED CONTEST
AND I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOW,
ON BEHALF OF THE MINOR. In consideration of the Foundation allowing the Minor to participate
in the Contest, I hereby release and hold harmless the Ryan Cameron Foundation and the Allstate
Foundation, their respective subsidiary and affiliated companies and all of their respective directors,
officers, shareholders, employees, agents, sponsors, successors and assigns (the “Co-Sponsor
Parties”), from any and all rights, claims, demands, losses, damages, expenses, costs and actions
(include reasonable attorneys’ fees) which I, the Minor, and our heirs, executors or assigns may
have in connection with the Minor’s participation in the Contest, including without limitations, any
bodily injuries, death, personal injuries or property damage that I or the Minor may incur or which
may arise or result from the Minor’s participation in the Contest. I acknowledge that the Minor’s
participation in the Activities shall be subject to the rules and regulations which the C-Sponsors or
Co-Sponsors Parties may require and that I shall be obliged to pay for any damage that I or the
Minor may cause in connection with the Minor’s participation in the Contest.
Further, on behalf of the Minor, I hereby grant the Co-Sponsors, Co-Sponsors Parties and their
sponsors the perpetual, worldwide right to make both visual and/or audio recordings and still
images of the Minor and to use the name, voice, likeness, picture, words, essay, poetry, artwork,
identity, biographical information or any material based on or derived whence forth, of the Minor in
connection with any of the Activities or any promotional/marketing materials associated therewith,
and/or other media (collectively, the “Media”) and for the purpose of advertising, marketing and/or
promoting the Co-Sponsors Parties and their sponsors. On behalf of the Minor, I agree that the
rights granted hereunder shall include the perpetual, worldwide right of the Co-Sponsors Parties
and their sponsor to edit, telecast, webcast, cablecast, rerun, record, publish, reproduce, use,
license, print, distribute or otherwise exploit the Media in any manner and in any medium or forum
whether now known or hereafter devised, in whole or in part, without any further compensation to
me and/or the Minor.
I warrant that I am of legal age and that I have every right to contract in my own name and on
behalf of the Minor.
Date:___________________________________________________________________________
Signature of Parent/Guardian:_______________________________________________________
Printed Name of Parent/Guardian:____________________________________________________
Parent/Guardian Telephone Number:_________________________________________________
Printed Name of Minor:____________________________________________________________
Address:________________________________________________________________________
City:____________________________ State:______________ Zip Code:____________________