Blue Awareness Activity Registration Form


Important Information:

  • Please complete all of the information on the form below to register your Out of the Blue Awareness Activity.
  • Deadline: Pre-Register as soon as possible to get maximum promotion of your activity(s). All completed Blue Awareness Activities must be submitted by April 15th, 2015 at 4:00 pm.

You may also drop off your submissions (photos, art, etc.) at 333 Reimer Avenue, Steinbach, MB.

Full Name

Address (Street, City/Town, Postal Code)

Telephone #

E-Mail Address

Confirm E-Mail Address

ACTIVITY SELECTION:
** You may select more than one Blue Awareness Activity.

 Blue Blossoms – any of the activities listed below, but completed by children 5 years and under. Please see submission requirements for this activity under each individual activity."]

 Blue Expressions – Any form of artistic expression. this can be in the form of artwork such as drawings, paintings, clay art, pottery, posters, gardening etc. The sky is the limit!"]

 Blue Performance - Any type of performance or presentation! Examples include public speaking, poetry, videos, music, songs, skit, play, choir etc. Get creative!!

 Blue Day – For communities, business, organizations, individuals and schools - Host your own Blue Day with Blue Awareness Activities. Encourage everyone to wear blue, have a blue bake sale, blue game, blue garden or flowers, etc. How much blue awareness can you incorporate into one day?

Agreement:

I understand and agree that all information including registration information, photos, videos or other materials submitted as part of my participation in the Blue Awareness Activities may be used by Southern Health-Santé Sud and the Southern Health-Santé Sud Suicide Prevention Committee to promote the Out of the Blue program.