DECLARATION AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK
[NAME OF CONTEST]
PLEASE READ CAREFULLY
- I, the undersigned, am the custodial parent or legal guardian of afriend or family member of the winner of a prize awarded in connection with the [NAME OF CONTEST]on [CHANNEL NAME(S)](the “Contest”),and who has been selected to accompany him or her in taking part in[Grand Prize/Secondary Prize](as defined in the Contest Rules).
- The [Grand Prize/Secondary Prize] consists of [DESCRIPTION].
[NOTE – the prize should be described the same way as in the Contest Rules]
- The estimated retail value of the [Grand Prize/Secondary Prize] isCDN$[●].
- In consideration of my child’sparticipation in the Contest and the[Grand Prize/Secondary Prize], and for all other good and valuable consideration, the sufficiency of which is hereby acknowledged, I hereby:
(a)declare that I am ______years of age or older, and have therefore reached the age of majority in the province of ______;
(b)declare that I am an eligible entrant as defined in the Contest Rules, I have read this Declaration and Release of Liability and Assumption of Risk, and I am fully familiar with, and agree to and with its contents;
(c)declare that I have read and understood the Contest Rules governing the Contest and that I have complied with, and will continue to comply with, all of the terms and conditions of the Contest Rules and of this Declaration and Release;
(d)accept the [Grand Prize/Secondary Prize]as awarded and confirm that this prize is non- transferable, non-exchangeable and non-reimbursable;
(e)understand that all costs and incidental expenses relating to and associated with the [Grand Prize/Secondary Prize]including, but not limited to [LIST EXPENSES AS DEFINED IN RULES, IF ANY](the “Expenses”) shall be the responsibility of the undersigned, and that none of the employees, directors or officers of any of the [LIST OF CONTEST SPONSORS EXACTLY AS OUTLINED IN RULES] (the “Contest Sponsors”)or any of the Affiliates (as defined in the Canada Business Corporations Act) or any of their respective advertising and promotional agenciesshall be held accountable for the Expenses.
[NOTE – this should read the same was as the Section relating to Expenses in the Contest Rules]
(f)authorize the Contest Sponsors or any of their respective advertising and promotional agencies to use my child’s name, city and/or, province/territory of residence, the photographs, likeness or images of my child, my child’s voice, and/or any verbal or written statements he or she made or may make about the [Grand Prize/Secondary Prize]or the Contest, for advertising, promotional or other purposes, at any time, in any manner and without restriction of any kind, in any media, on any support and in any country of the world, the whole without any compensation.
(g)understand that acceptance of the [Grand Prize/Secondary Prize]may involve danger and/or exposure to risks and hazards whether arising from foreseeable or unforeseeable human error or negligence, and that, as a result, I or we may suffer damage to personal property, serious personal injury, illness or even death, but I nevertheless freely and voluntarily agree and hereby assume any and all risks of property damage, personal injury, illness or death arising out of or connected with my child’s participation in the Contest or my acceptance of the[Grand Prize/Secondary Prize];
(h)fully and forever release and hold harmless each of the Contest Sponsors, the Affiliates, and any of the advertising or promotional agenciesand all of their respective successors, assigns, agents, employees, representatives, shareholders, officers and directors and all others associated with the development and execution of the Contest (collectively, the “Releasees”) from any and all liability arising in connection with my child’s participation in the Contest and accepting the Grand Prize, including, without limitation, any financial, legal or moral responsibility or loss or personal injury, illness or death or damage to or loss of property suffered or incurred or arising from mychild’s participation in the Contest or my acceptance ofthe[Grand Prize/Secondary Prize], whether suffered by me, my child, or by our respective heirs, executors, administrators, successors or assigns, notwithstanding that such injuries or losses may have been contributed to or occasioned by the negligence or gross negligence of any of the Releasees;
(i)agree that I shall not make any claim or take any proceedings against any person with respect to any matter that may have arisen in connection with my child’s participation in the Contest or my acceptance of the[Grand Prize/Secondary Prize]in which a claim could arise against any of the Releasees for contribution or indemnity or other relief; and
(j)fully indemnify the Releasees from any and all claims on the part of any third party or parties related in any way to my child’s participation in the[Grand Prize/Secondary Prize] including, without limitation, any claim related to the death or personal or property damage or injury of any person.
- All of the foregoing shall inure to the benefit of and be binding upon the successors, assigns, heirs, administrators and executors of the undersigned, as the case may be.
- I understand that the present form must be duly signed by me and returned to [TITLE]at [ADDRESS]within [# OF DAYS]working days following its reception, failure to which the attribution of the [Grand Prize/Secondary Prize]may be forfeited.
- This Declaration and Release of Liability and Assumption of Risk does not extinguish any or all other releases and waivers that I signed in relation to the Contest.
- This Declaration and Releaseof Liability and Assumption of Risk shall be governed by and construed in accordance with the laws of the Province of [PROVINCE].
- I declare that I have carefully read this Declaration and Release of Liability and Assumption of Risk, understand its contents, and consent to it of my own free will.
IN WITNESS WHEREOF, I declare that I am the parent or legal guardian of the party named below, who, as of today’s date, as evidenced below, is under the age of majority in his or her province of residence, who has been selected by the winner of the Grand Prize to accompany him or her in the Grand Prize, and I understand and agree that by signing below, I bind him or her to the terms of this Declaration and Release of Liability and Assumption of Risk:
Name of Parent or Legal Guardian: / Name of minor (print):Signature of Parent or Legal Guardian: / Phone #:
Date: / Address:
Witness Name: / Witness Signature: