“Create Resilience Youth Art Contest For Suicide Prevention”
Entry & Permission Form

*Both the Parent and Youth need to complete this form. Thank you.*

Youth's Name

First Name

Last Name

Youth's Email

Name of Parent and/or Guardian

First Name

Last Name

Parent's and/or Guardian's Phone Number

(###)

###

####

Parent's and/or Guardian's Email

Youth's School & Grade

Write N/A if not applicable

Youth's Age

Youth submitting creative work completes the following:

I want the Hold On Campaign for Suicide Prevention to post my creative work on their website.

Yes

No

I want the Hold On Campaign for Suicide Prevention to share my work with national and international suicide prevention organizations

Yes

No

I am interested in being interviewed and having my creative work published in the media if I am one of the top 10 finalists.

Yes

No

I would like my name displayed on my creative work as:

My age and full name

My age, first name and first initial of my last name

Please share your ideas on what can lead to suicide and how we can improve youth mental health. How does your creative work express those ideas?

Why is the "Create Resilience Youth Art Contest for Suicide Prevention" important to you?

Add a link to your creative work here (Youtube, Soundcloud, Google Drive, Dropbox, etc.):

PARENTAL CONSENT: I give permission for my child to enter the "Create Resilience Youth Art Contest for Suicide Prevention." In the space below the parent/guardian types their first and last name, states the month/date/year, followed by the words: I have reviewed this Entry & Permission Form and give my consent for my child's participation.

Submit Your Work: 13 to 17 year old

“Create Resilience Youth Art Contest For Suicide Prevention”Entry & Permission Form

“Create Resilience Youth Art Contest For Suicide Prevention”
Entry & Permission Form