Welcome to the Department of Toxic Substances Control

P2 Week Video Contest Entry Form

Please submit one entry form per video.

Before filling out this form, please set your entry as a video response (put the cursor in the comments box below the video on YouTube and the video response option will appear) to our promo video.

 




Have you sent your entry as a video response to the promo video?
   
   


Are you, or a member of your immediate family an EPA Employee, Contractor or Grantee?
   
   

   
   


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 P2 Week Video Contest, I certify I, or my minor child, am the creator of the video listed above. I hereby grant the Department of Toxic Substances Control (DTSC) and the Western Sustainability and Pollution Prevention Network (WSPPN) 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 DTSC and will not be returned. I hereby irrevocably authorize DTSC and WSPPN to edit, alter, copy, exhibit, publish or distribute this video for purposes of publicizing DTSC and WSPPN'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 DTSC and WSPPN 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.

  mm/dd/yy
 
 
 
 
Copyright © 2007 State of California