Cape Assist & HCC PSA Contest

Cape Assist & Cape May County Healthy Community Coalition Public Service Announcement

Deadline Friday, March 13, 2026
HCC, a community initiative of Cape Assist, is striving to increase protective factors and reduce risk factors for substance misuse among youth in our community. This year’s topics will focus on the importance of staying drug-free and building resilience!

The contest is open to all students in grades K-12 in Cape May County.

(Younger students may need the help of an adult to discuss and choose a topic from one of the four topics below)

Students are invited to create a poster/art PSA or a 60-second video (or less), or a written PSA on one of the following four topics:
- Mental Health: It’s Okay to Talk About It
- Why I Choose to Be Drug-Free
- Don't Puff Away Our Planet
- Real-Time vs Screen-Time
Entries are due by Friday, March 13, 2026

Before completing the PSA submission form:
- Individual PSA entries will require parent/legal guardian information and signature to complete/submit the form. Forms should be completed together with the student and their parent/legal guardian.
- Group PSA entries - students will need to have their parent/legal guardian complete a waiver and consent form, which can be found on the website, or ask their advisors for a print version. Group entries without all participants' parent/legal guardian waivers and consent forms will not be reviewed and will be deemed ineligible for the PSA contest.

GENERAL INFORMATION:
PSA Category:*
Is the PSA Entry going through a school? Or a club (not affiliated with a school)?*
School Name:*
School Name:*
Club/Organization Name:*
Advisor's Name:*

First NameLast Name
Advisor's Email:*

Confirmation Emailexample@example.com
Is the PSA being Submitted by a Group? Or Individual?*
Students can have as many extras in the video/group as they like, but only 5 will be able to represent and attend the breakfast. Written PSAs are limited to 1 individual and cannot be a group.
Group Size (max of 5 representatives from a group will be able to attend the awards breakfast):*
Students can have as many extras in the video/group as they like, but only 5 will be able to represent and attend the breakfast.

STUDENT INFORMATION:
Student 1: Name:*

First NameLast Name
Student 1: Current Grade:*
Student 1: Student Email:*

Confirmation Emailexample@example.com
Student 1: Legal Parent/Guardian Email:*

Confirmation Emailexample@example.com
Student 2: Name:*

First NameLast Name
Student 2: Current Grade:*
Student 2: Student Email:*

Confirmation Emailexample@example.com
Student 2: Legal Parent/Guardian Email:*

Confirmation Emailexample@example.com
Student 3: Name:*

First NameLast Name
Student 3: Current Grade:*
Student 3: Student Email:*

Confirmation Emailexample@example.com
Student 3: Legal Parent/Guardian Email:*

Confirmation Emailexample@example.com
Student 4: Name:*

First NameLast Name
Student 4: Current Grade:*
Student 4: Student Email:*

Confirmation Emailexample@example.com
Student 4: Legal Parent/Guardian Email:*

Confirmation Emailexample@example.com
Student 5: Name:*

First NameLast Name
Student 5: Current Grade:*
Student 5: Student Email:*

Confirmation Emailexample@example.com
Student 5: Legal Parent/Guardian Email:*

Confirmation Emailexample@example.com

LEGAL PARENT/GUARDIAN INFORMATION
Legal Parent/Guardian Name:*

First NameLast Name
Legal Parent/Guardian Phone:*
Please enter a valid phone number.
Legal Parent/Guardian Email:*
example@example.com

LEGAL WAIVER AND CONSENT
I, {name}, hereby grant permission as the legal parent/guardian of {student1} to participate in the Cape Assist and Cape May County Healthy Community Coalition’s Public Service Announcement Contest. I understand and consent to my child’s name, photo, age, grade, attending school, likeness, appearance, image, voice, video, and artwork may be used for promotional, advertising, and educational material, including but not limited to print, digital, direct mail, and for use on the internet for an indefinite duration. In addition, I understand that any other student present in the submitted PSA must complete and submit a consent form.

I grant additional permission to Cape Assist and Cape May County Healthy Community Coalition that any information or materials submitted may be altered as they see fit. I waive any right to approve the final product. In addition, the student and student’s legal parent/guardian agree to indemnify and hold harmless Cape Assist and Cape May County Healthy Community Coalition, its officers, employees, and agents from and against any claims, actions, costs, judgments, or damages of any type relating to the production or distribution of the materials submitted during the contest.

I acknowledge that I will not receive any compensation other than the prize(s) set forth by the contest if my submission is selected.
Legal Parent/Guardian's Name:*

First NameLast Name
Legal Parent/Guardian's Signature:*

Must be completed for students under 18
Today's Date*

MonthDayYear
Date
For any questions and/or comments, please email Natalia at natalia@capeassist.org.

SUBMISSION INFORMATION:
PSA Topic for your PSA Entry:*
Give your PSA a Unique Title:*
Title cannot be the same as PSA Topic.
Type PSA Below or use the upload option:*

0/250
The title of your PSA cannot match the topics. Please select another title.
Upload PSA Submission:*

Video PSAs MUST be 60-seconds or less. Accepted file formats: .MOV, .MPEG4, .MP4, .AVI, .WMV, .JPG, .JPEG, .PNG
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Cape Assist & Cape May County Healthy Community Coalition Public Service Announcement

GENERAL INFORMATION:

STUDENT INFORMATION:

LEGAL PARENT/GUARDIAN INFORMATION

LEGAL WAIVER AND CONSENT

SUBMISSION INFORMATION: