Darien Library Teen Film Contest
Entry Form
Instructions:
 Submit one Entry Form for every film submitted.
 Fill out the Entry Form completely (both sides!).
NAMES (Pr in t ):
1 .________________________
2 .________________________
3 .________________________
4 .________________________
TELEPHONE:
1 .________________________
2 .________________________
3 .________________________
4 .________________________
EMAIL:
1 .________________________
2 .________________________
3 .________________________
4 .________________________
TITLE OF ENTRY:
__________________________
__________________________
Ple ase Se e Re v e r se Sid e .
All p er so n s ap p ear in g o n
f ilm m u st sig n t h e en t r y
f o r m , an d h ave t h eir
p ar en t s sig n f o r p eo p le
u n d er 18 year s o ld .
I cer t if y t h at t h is is o r ig in al
On e Book, On e Com m un it y 2 0 1 0
w o r k t h at d o es n o t vio lat e an y
co p yr ig h t law s, an d I ag r ee t o
r elease m y f ilm t o Dar ien
Lib r ar y. Th e Lib r ar y h as m y
p er m issio n t o r ep r o d u ce,
p u b lish , o r exh ib it t h is w o r k in
an y w ay, at an y t im e an d t o list
m y/o u r n am e(s) as t h e
au t h o r s. I u n d er st an d t h at t h e
f ilm m ay b e p u b lish ed o n lin e.
_________________________
Sig n at ur e
__________________________
Par e n t ’s Sig n at ur e
__________________________
Sig n at ur e (2n d gr o up m em b er )
__________________________
Par e n t ’s Sig n at ur e (2n d g.m .)
__________________________
Sig n at ur e (3r d gr o up m em b er )
__________________________
Par e n t ’s Sig n at ur e (3r d g.m .)
__________________________
Sig n at ur e (4t h gr o up m em b er )
__________________________
Par e n t ’s Sig n at ur e (4t h g.m .)
 Films must be submitted on CD, DVD or flash drive.
Flash drives cannot be returned.
 Enter by April 30, 2010.
Contest Rules:
 Films should be between 1-5
minutes.
 Any person appearing on film must
have their full name, signature and
parent’s signature (for under-18s)
included on the entry form.
 The film should include a title screen
and credits (director, video editors
and actors names included).
 The entry must be original work.
 School assignments will be
accepted.
 You may enter as a group.
 Films can be in any genre: fictional,
documentary, video podcast,
animation etc.
 Judging will be based on content,
creativity, style, and technique.
 The Library reserves the option to
publish entered films to Vimeo,
Youtube and/or our website. Videos
will be credited to their authors.
 To submit entries, bring your disc
and entry form to the library.
 Entries must be received by April
30th, 2010.
 For questions, please call 669-5225
or stop by the Teen Lounge.
 Good luck!
 Darien Library Teen Film Contest
Entry Form On e Book, On e Com m un it y 2 0 1 0

For a film to be eligible for the contest, every person who is filmed must sign this form.
If the person is under 18, the person’s parent or guardian must also sign.

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p at ed in as p ar t o f t h e Teen Film Co n t est m ay b e p u b lish ed
Film Participants & Parents:
o n lin e:  Entries in the Darien Library
1. Actor’s name:_________________________________________________ Teen Film Contest may be
Actor signature:__________________________________________________ exhibited online, including on
Actor’s parent’s signature:_________________________________________
the Darien Library website and
our channels on Vimeo and
2. Actor’s name:_________________________________________________
Youtube.
Actor signature:__________________________________________________
 By signing this form, you
Actor’s parent’s signature:_________________________________________
consent to participation in a
3. Actor’s name:_________________________________________________
movie that may be published
Actor signature:__________________________________________________ online.
Actor’s parent’s signature:_________________________________________
 Please be advised that you can
4. Actor’s name:_________________________________________________
always contact Teen and
Actor signature:__________________________________________________ Technology Services at Darien
Actor’s parent’s signature:_________________________________________ Library if you have concerns.
5. Actor’s name:_________________________________________________ For questions, please call
Actor signature:__________________________________________________ Sarah Ludwig at 669-5225 or
Actor’s parent’s signature:_________________________________________
stop by the Teen Lounge.
6. Actor’s name:_________________________________________________
Actor signature:__________________________________________________
Actor’s parent’s signature:_________________________________________
7. Actor’s name:_________________________________________________
Actor signature:__________________________________________________
Actor’s parent’s signature:_________________________________________
8. Actor’s name:_________________________________________________
Actor signature:__________________________________________________
Actor’s parent’s signature:_________________________________________
9. Actor’s name:_________________________________________________
Actor signature:__________________________________________________
Actor’s parent’s signature:_________________________________________
10. Actor’s name:________________________________________________
Actor signature:__________________________________________________
Actor’s parent’s signature:_________________________________________