Blue Awareness Activity Submission Form


Deadline: Wednesday, April 15th, 2015 at 4:00 p.m.

Full Name

Address (Street, City/Town, Postal Code)

Telephone #

E-Mail Address

Confirm E-Mail Address

Award Category

Attach Submission Requirements:
Activity Summary (MS Word only). Your summary should include a paragraph or two with information like: where and what activity did you do, who and how many people participated, who was your target audience, and, what was the key mental health message or theme highlighted? eg. Having a trusted adult to share our feelings with is very important, or, focusing on what we have to be thankful for can help us feel better because our thoughts affect our mood, etc. If you would like help with your choosing or implementing your mental health message, check out our Learn page, or just contact us or the guidance counsellor at your school, and we would be happy to help you. Remember to add any photos or videos that you have taken of your activity. Please label them clearly or refer to them in your summary.
Materials: (Photos, Video, Posters etc.)
**NOTE: The total size of all files must be less than 5MB. If the total size is greater than 5MB, please send a ZIP file.





Agreement:
By entering your Blue Awareness Activity, you acknowledge and agree that all materials (including Submission Forms and Requirements such as activity summaries, photos, videos etc.) may be used for promotional purposes by Southern Health-Santé Sud. You also confirm that you have obtained the consent of any persons appearing in any photos or videos.

I agree and confirm.

Please note:
If you would prefer to mail or drop off your Form, and any accompanying materials, please do so at this address:

Out of the Blue
Community Mental Health Program
365 Reimer Avenue
, Steinbach, MB, R5G 0R9
E-Mail: outoftheblue@southernhealth.ca