DBTL Submission Form

Don't Buy the Lie Contest Submission

Thank you for participating in the "Don't Buy the Lie" contest! Please take the time to fill out your information and submit your entry below! If you have any questions, contact Linh Vo at mvo@healthedcouncil.org. Deadline: March 6, 2026. Check out past winners on our website: https://linktr.ee/hec_wellnessed
Your Name*

First NameLast Name
Your Email*
Please do NOT use your school email. We will be unable to contact you.
Confirm Your Email*
Please do NOT use your school email. We will be unable to contact you.
Your Phone Number
School Name*
Grade Level*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Confirm Your Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
This is our website below (https://linktr.ee/hec_wellnessed):
As part of the requirements, did you follow all directions under the DBTL Judging Criteria?*

YesNo
As part of the requirements, did you watch our educational videos on our website?*

Yes, I watched your DBTL videos on your website.No
Before participating in this contest, how aware were you of the risks associated with tobacco/marijuana use (scale of 1-5)*

1

2

3

4

5

1 is 1 = Not at all, 5 is 5 = Very aware
After watching our educational videos on our website, I learned about the impact of Big Tobacco's lies and how they are affecting people's lives and the environment. *

1

2

3

4

5

1 is 1 = Not at all, 5 is 5 = A lot
What were the some things you learned after creating your contest entry and participating in our "Don't Buy the Lie" contest?*
How did you hear about this contest?*

Instagram, Facebook, LinkedInEmailFlyerOther
What topic does your creation include? (Select all that apply)*

Anti-tobacoAnti-vapingAnti-marijuana
What type of creation are you submitting?*

Video (dances, skits, music, etc)Digital artHandmade art (sketch, painting, mixed media, etc.)Writing (song lyrics, spoken word, or poetry)Other
Did you work on this submission by yourself or with a group?*

By myselfWith a group
I understand that it is optional to work on a submission with a group, but one person has to submit the project. If the submission wins, the prize money will only go to the person who submitted the project under their name. It is their responsibility to distribute the prize with the group.*

I understand
File Upload*

If you're submitting a music video, can you please submit lyrics in a Word Doc as well. (File types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, mp4, wma, mpg, flv, avi, jpg, jpeg, png, gif)
Cancelof
By participating in the Don't Buy the Lie contest, I consent to being photographed, filmed, and/ or recorded by the Health Education Council (HEC) and/ or approved third party vendors. I release HEC from any liability and understand the photo, video, or recording may be edited, published, and distributed externally for lawful purposes.

YesNo
What are ALL of the names and initials of the person(s) shown in your video? (Name & Initials = John Doe, JD)
What are ALL of the names and initials of their parent/guardian(s)? (Name & Initials = John Doe, JD)
I hereby authorize Health Education Council, Kaiser Foundation, Kaiser Foundation Health Plan, Inc., The Permanente Medical Group, Inc., and any persons or entities acting at the request or discretion of Kaiser Permanente to display, distribute, reproduce, site, alter, and otherwise use the entry. I relinquish any and all ownership interest of or legal right related to the entry, and acknowledge that the entry is, after I submit it, the exclusive property of Health Education Council and Kaiser Permanente.
Youth Applicant's Signature*

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Parent/Guardian's Signature*

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Do you have any additional comments or concerns?
Birthdate*

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Date
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Don't Buy the Lie Contest Submission