Don't Buy The Lie!

Contest submission form

For those who prefer to fill out a paper form, you may download and print the 2019 DBTL Entry form instead.

 

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Student information

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School Information

Constest submission

By the act of submitting my entry to your contest, I hereby authorize 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 Kaiser Permanente.

(reminder: You may enter multiple times, but only 1 image per entry.)

Release / consent

By the act of submitting my entry to your contest, I hereby authorize 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 Kaiser Permanente.

Student consent

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Parent/Guardian consent

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Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 • Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 • Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232