Entry Form

Step 1: Complete the entry form below with an adult.
Step 2: We'll send you an email with a link to upload your video.
Step 3: Watch the website for contest winners!

Please submit one entry form per video.

Your Name
Your Email
Phone Number
Street Address
Address 2
City
State or Country
Zip
Your School Name
School Address
School Address 2
School City
School State or Country
School Zip
Video Title
Please provide a brief description of your video
How did you hear about the contest?
Additional Students who contributed to this video
I agree to the Rules & Eligibility for the ShowGreenTV II Student Film Challenge.
View Rules & Eligibility.
I have obtained permission to submit this video from all persons (or their parent/guardian if under 18) who appear in my video.
Age
select
5
6
7
8
9
10
11
12
13
14
15
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19
Parent/Guardian Full Name (if under 18)
Parent/Guardian Email (if under 18)
Parent/Guardian Phone Number

EWM Video Release – to be filled out by individuals over 18 submitting videos or their parent or guardian if they are under 18

As an entrant in the Energy Works Michigan (Energy Works) "Show Green" Film Contest, I certify I, or my minor child, am the creator of the video entitled "." I hereby grant Energy Works permission to use my video for any and all purposes, without further payment or any other consideration.

I understand and agree that these materials will become the property of Energy Works and will not be returned.

I hereby irrevocably authorize Energy Works to edit, alter, copy, exhibit, publish or distribute this video for purposes of publicizing Energy Works Michigan's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy.

Additionally, I waive any right to royalties or other compensation arising or related to the use of the video.

I hereby hold harmless and release and forever discharge Energy Works from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I attest that all statements made in the video are true to the best of my knowledge.

I am 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Name

Date

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