Form Instructions

On-Screen Release Form

For the HMSA Teen Video Awards Contest, students, working individually or in teams, compete to create and produce the best public service announcements on a teen health issue.

Please complete and print this form. Submit it with all of your TVA materials according to the contest rules. Submission deadline is 4 p.m. on March 4, 2013.

Please make sure all of your TVA materials are completed.

1. Fill in your team leader’s name, sponsoring school, and video title.
2. Each person who appears in your video must read the conditions of the agreement, fill in their name and date, sign the form, and fill in their complete address.
3. If the person who appears in your video is under age 18 as of March 4, 2013, the actor’s parent or legal guardian must fill in their own name, sign their name, and date the form.