Protect Me With 3+ Video Contest Guidelines and Forms

Protect Me With 3+ Video Contest Guidelines and Forms 1. Review video contest guidelines and forms. 2. Complete Application Form (Note: each participant involved in the creation and performance of the video must complete this form) 3. Complete Photo and Video Consent Form (Note: each participant involved in the creation and performance of the video must complete this form) 4. Mail-In all Forms together. Must Be Postmarked by Nov. 23: Protect Me With 3+ C/O Springboard PR 17 N Main St. Marlboro, NJ 07746 5. Individual/Team Captain Complete Online Submission Form to Upload Video 6. Upload Video

STEP 1: REVIEW VIDEO CONTEST GUIDELINES AND FORMS Protect Me with 3+ Video Contest The Partnership for Maternal and Child Health of Northern New Jersey in collaboration with the New Jersey Department of Health is launching the third annual Protect Me with 3+ contest for youth to educate each other and their parents about the importance of getting vaccinated. The Protect Me with 3+ collaborators are challenging all New Jersey students in 9 th grade through 12 th grade to raise awareness about one of the four vaccines youth need: 1. Dose of Tetanus-diphtheria-acelluar pertussis vaccine (Tdap) 2. Doses of Meningococcal conjugate vaccine (MCV4) 3. Doses of Human papillomavirus (HPV) vaccine + Influenza (flu) vaccine each year New This Year: Flu Vaccine added to the contest Show the world you can be the next Picasso or Spielberg! Why are adolescent vaccines important? Vaccines protect youth from serious and life-threatening diseases such as tetanus, meningococcal, pertussis (whooping cough), flu, and genital cancers. As youth get older, some childhood vaccinations begin to wear off so youth need a booster (an additional dose) to stay protected. Changes in behavior increase youth s exposure to certain diseases. Vaccines also protect the people around youth who are not able to get vaccinated. Learn more about the importance of adolescent immunizations at www.protectmewith3.com Winning Entries: The winning entries will be posted on www.protectmewith3.com. The following prizes, provided by The Partnership for Maternal and Child Health of Northern New Jersey, will be awarded: Video Contest (9 th -12 th grade): 1 st Place: $350 gift card Chance for videos to be played in provider offices 2 nd Place: $200 gift card 3rd place: $100 gift card Classroom Prize: $100 gift card Classroom with the most eligible submissions

Protect Me with 3 + Contest Timeline: Oct. 16 Nov. 23 Contest Starts! End of Video contest; All Application and Photo & Video Consent Forms must be postmarked and videos submitted by midnight Dec. 8 Dec. 9 Dec. 9-21 Dec. 22 Jan. 8 Jan. 9 Top 5 finalists per contest category are notified Announcement of top 5 finalist per contest category Public voting on www.protectmewith3.com; voting ends at midnight Top 3 winners in each category notified Award Ceremony; [Location & time TBD] (Snow date: Jan. 13) Winners announced on www.protectmewith3.com (Snow date: Jan. 14) Selection Process: Finalist: An internal panel consisting of public health experts will select 5 finalists.. Entries will be judged on: Creativity/originality Vaccination message Visual effectiveness Audio clarity Overall appeal Public Voting: The public will vote on the finalists from Dec. 9 to Dec. 21, 2014 via www.protectmewith3.com. Individuals will be able to vote for their favorite video once a day for two weeks. The videos that receive the most votes during the voting period will be deemed contest winners. If you have any questions please email help@protectmewith3.com.

GENERAL CONTEST RULES: 1. Students must be residents of New Jersey. 2. A group of students may enter the contest, but prizes will be awarded per entry, not per individual participant. 3. Group entries should only be submitted one time by one group member (the Team Captain). 4. Each student can only work on one entry, either as an individual or as a group. 5. Entries must be students original work and contain no copyrighted material. 6. To ensure the most current information is used, entries shall only use information provided on www.protectmewith3.com. Do not use information obtained from other organization websites listed in the resource sections. Entries using information from other sources will be disqualified. 7. Entries must focus on one vaccine. 8. Students under the age of 18, will need parent/guardian consent to participate. 9. Each participant involved in the creation of the video must complete the Submission Form and Photo and Video Consent Form. For group entries, the Team Captain is responsible for collecting and mailing all forms together. 10. All winners will be notified of their selection by e-mail. 11. All submissions will become the property of Protect Me With 3 and its sponsors. All rights for reproduction in all media including print, film, and/or video are assigned to the organizers and their sponsors to use as deemed appropriate for the goals of the contest and the Protect Me With 3 campaign. Entries must NOT contain: 1. Spelling mistakes or mispronunciations 2. Information from the resources section of www.protectmewith3.com or from other organizations/sources 3. Information on more than 1 vaccine 4. Brand names or trademarks of vaccines 5. Brand names or logos of commercial products (i.e. clothing, sports teams, food) 6. Material that violates or infringes another s rights, including but not limited to privacy, publicity or intellectual property rights, or that constitutes copyright or license infringement 7. Material that is inappropriate, indecent, obscene, hateful, defamatory, slanderous or libelous 8. Material that promotes bigotry, racism, hatred or harm against any group or individual or promotes discrimination based on race, sex, religion, nationality, disability, sexual orientation or age 9. Material that is unlawful, in violation of or contrary to the laws or regulations in any state where the entry is created 10. Entries must not have been submitted previously in a promotion or contest of any kind, or exhibited or displayed publicly **Any entry that does not follow contest rules will be disqualified.**

VIDEO Contest Rules Eligibility: 9 th grade through 12 th grade students who are New Jersey residents Format: 1. The video can be up to 30 seconds long. *Videos over 30 seconds will be disqualified. 2. Videos must be submitted in one of the following formats:.avi,.mov,.mp4, MPEGPS, or.wmv. Content: 1. The video must cover only 1 of the four vaccine categories (Tdap, HPV, meningococcal conjugate vaccine or flu). *A video discussing more than one vaccine will be disqualified. 2. The videos must contain at least 3 facts from www.protectmewith3.com such as a. Why you need to be vaccinated b. Facts about the disease(s) the vaccine prevents *Entries with information from other sources will be disqualified 3. The videos must contain the statement: For more information go to www.protectmewith3.com a. This statement can be spoken or written as text in your video 4. The videos must contain the statement: Talk to your parents about getting vaccinated. Your health is worth a shot! a. This statement can be spoken or written as text in your video

Video Submission Checklist For Team Captains of Group Submissions: Complete one GROUP INFORMATION FORM Complete PROTECT ME WITH 3+ VIDEO CONTEST APPLICATION FORM with your parent or guardian. Complete CONSENT TO USE PHOTOGRAPHS OR VIDEOS BY A STUDENT FOR NONPROFIT USE FORM with your parent or guardian. Collect completed PROTECT ME WITH 3+ VIDEO CONTEST APPLICATION FORM from EACH group participant. Collect completed CONSENT TO USE PHOTOGRAPHS OR VIDEOS BY A STUDENT FOR NONPROFIT USE FORM from EACH group participant. Mail all forms in one package by NOV. 23, 2014 Complete the online submission form on www.protectmewith3.com with your parent or guardian. Upload your group s video on www.protectmewith3.com by midnight Nov. 23, 2014. For Individual Submissions: Complete PROTECT ME WITH 3+ VIDEO CONTEST APPLICATION FORM with your parent or guardian. Complete CONSENT TO USE PHOTOGRAPHS OR VIDEOS BY A STUDENT FOR NONPROFIT USE FORM with your parent or guardian. Mail all forms by NOV. 23, 2014 Complete the online submission form on www.protectmewith3.com with your parent or guardian Upload your video on www.protectmewith3.com by midnight Nov. 23, 2014. *Videos with missing application or consent forms will be disqualified

STEP 2: COMPLETE VIDEO CONTEST APPLICATION FORM (Note: each participant involved in the creation and performance of the video must complete this form) Protect Me With 3+ 2014 Video Contest APPLICATION FORM Video Title: Individual entry Group entry Student s Name: Grade: Age: Teacher: School: Student s Home Phone: Student s E-mail Address: Team Captain s Name (Group entry only): THE FOLLOWING MUST BE SIGNED BY THE STUDENT AND PARENT: I have read and agree to all rules of the Protect Me With 3+ Video Contest and agree that my (our) video entry becomes the property of Protect Me With 3 and its sponsors and may be displayed, distributed, donated or used in any way deemed appropriate to meet the goals of Protect Me With 3. I certify that this video is my (our) original work as witnessed below by my parent. COPPA Disclosure The Children's Online Privacy Protection Act (COPPA) was passed to give parents increased control over what information is collected from their children online and how such information is used. The law applies to websites and services directed to, children under the age of 13. www.protectmewith3.com is committed to protecting the online privacy of the children who visit its website and to comply with COPPA. COPPA prohibits unfair or deceptive acts or practices in connection with the collection, use or disclosure of personally identifiable information from and about children on the Internet. Parental Consent We will not collect any information without parental consent and the information will be used only for the purpose of the immunization contest. Site traffic records During the voting process, www.protectmewith3.com will collect information on domain names, dates and times of visits to www.protectmewith3.com. This information includes no personal identifiers and allows us to record website traffic to improve navigation and content. Cookies www.protectmewith3.com does not require the use of per-session cookies. Cookie information is never sold, given or disclosed to third parties. Email www.protectmewith3.com may ask for feedback via email to improve the campaign for the upcoming year. Email information is collected only for participants in order to inform them of their winning status. Email information is never sold, given or disclosed to third parties I have read the COPPA disclosure and agree to the terms STUDENT S SIGNATURE & DATE PARENT OR GUARDIAN S SIGNATURE & DATE OF STUDENT IF UNDER 18

STEP 3: COMPLETE PHOTO AND VIDEO RELEASE (Note: each participant involved in the creation and performance of the video must complete this form) CONSENT TO USE PHOTOGRAPHS OR VIDEOS BY A STUDENT FOR NON-PROFIT USE (e.g. educational, public service, or health awareness purposes) Student Name: School: Birth Date: I hereby consent to the participation in media interviews and the use of quotes, photographs, movies or videos of, or developed by, the Student named above by The Partnership for Maternal and Child Health of Northern New Jersey ( Partnership ). I also grant to New Jersey Department of Health the right to edit, use, and reuse said materials for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release the New Jersey Department of Health and the Partnership and their employees, or agents working on their behalf, from all claims, demands, and liabilities whatsoever in connection with the above. Signature of Parent/Guardian (if Student is under 18): Date: Address of Parent/Guardian: OR Signature of Student (if 18 or over): Date: Address of Student:

STEP 3 TEAM CAPTAIN ONLY: COMPLETE GROUP INFORMATION FORM *The Group Information Form does not need to be completed for individual submissions Group Information Form Team Captain Name: Group Members: FULL NAME E-MAIL ADDRESS *ALL PARTICIPANTS INVOLVED IN THE PRODUCTION OR PERFORMANCE OF THE VIDEO MUST BE INCLUDED ON THIS LIST. BOTH THE APPLICATION AND CONSENT FORM MUST BE INDIVUALLY FILLED OUT BY ALL PARTICIPANTS AND MAILED IN WITH SUBMISSION PACKAGE.

STEP 4: MAIL IN ALL FORMS. (Must be postmarked by Nov. 23, 2014) Address: Protect Me With 3+ C/O Springboard PR 17 N Main Street Marlboro, NJ 07746 STEP 5: COMPLETE ONLINE SUBMISSION FORM TO UPLOAD VIDEO STEP 6: UPLOAD VIDEO You have completed your Protect Me With 3+ Contest Submission, Good Luck!