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Safe Jobs for Youth Month Video Contest Entry Form
Entries must be submitted by Monday, January 9, 2017, 5:00pm
Title of Production:
Subject of My Video:
#1 Every Job Has Hazards
#2 Hazards Can Be Addressed
#3 Laws Protect All Workers on the Job
#4 Special Laws Protect Teen Workers
#5 What if You Are Injured
#6 How to Problem-solve and Get Help
Video Producer's Name:
Student's home number:
Student's cell number
Teacher's phone number:
Is this a team or individual entry?
Contact Student or Teacher?
Copyright Clearances & Information:
List all audio and visual sources (music, video footage, etc...) and Permissions ( Please download the video permission form on our website and email a signed copy to
or mail to address provided)
Video Link (Please send a YouTube link) *If you would like to submit your video via email, please contact
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