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CONTEST
(the "Contest")
DECLARATION OF COMPLIANCE AND RELEASE ("Release")
I do hereby declare that I, of , , am a selected entrant (the "Entrant") in the Contest. I understand that I will be awarded a prize consisting of (the "Prize") if I complete this Release and Declaration of Compliance and otherwise comply with the Contest rules ("Official Rules"), and that at that point I will be a winner (a "Winner").
In consideration of the awarding of the Prize to me, I hereby:
| (a) | acknowledge that I have read, have complied, and will comply with all the rules, regulations, terms and conditions set forth in the Official Rules; that I have not perpetrated and will not perpetrate any fraud or deception in connection with the Contest and have not sought to influence the outcome of the Contest other than by participating as expressly permitted in the Official Rules. |
| (b) | acknowledge that the Prize is as described in the Official Rules (incorporated herein by reference); |
| (c) | agree that I will accept the Prize as awarded; |
| (d) | agree to be responsible for all federal, state, and local taxes associated with Prize acceptance; |
| (e) | release, indemnify and hold harmless ("Sponsor"); their respective parents, subsidiaries and affiliates and advertising and promotion agencies; the employees, officers, directors, representatives and agents of each of the foregoing; and the heirs, executors, administrators, personal representatives, successors and assigns of the foregoing (collectively, "Releasees") from any claims, demands, payments, actions, or causes of action for damages, loss or injury, arising as a result of my participating in the Contest and accepting the Prize, which I or my heirs, executors, administrations, personal representatives or assigns may now or hereafter have against them; |
| (f) | grant Sponsor and any of Sponsor's clients or designees the right to use my name, city of residence and any image taken of me by or on behalf of Sponsor, in connection with the Contest, in any and all media now or hereafter devised without limitation and without additional compensation, notification or permission or other liability to me or my heirs, executors, administrators, personal representatives or assigns; and |
| (g) | declare that; |
| 1) | I am a legal resident of either the 50 United States or District of Columbia; |
| 2) | I was at least 18 years of age at the time of entry; |
| 3) | I nor anyone with whom I live (whether or not related) or any of my immediate family members (spouse, parent, child, sibling or their respective spouses, regardless of where they reside) is an employee, officer, director, representative of Sponsor or any of their respective parents, subsidiaries, affiliates or advertising and promotion agencies; and |
| 4) | The terms of the Official Rules and this Release shall apply to and be binding on me and my heirs, executors, administrations, personal representatives and assigns. |
| (h) | warrant and represent that I have full right and power to enter into this Release, and that the terms of this document do not in any way conflict with any existing commitment on my part. |
| (i) | agree that this Release supersedes any prior understandings between me and Sponsor relating to the rights granted herein and no provision of this Release can be modified by any other instrument, invoice or document unless in writing and signed by the parties hereto. |
| (j) | acknowledge this is a complete RELEASE and DISCHARGE of all claims and rights of the undersigned against the Releasees, and that no action will be taken by or on behalf of the undersigned with respect to any such rights; it being understood that this release shall be binding upon the parents, guardians, heirs, executors, and administrators of the undersigned. |
| (k) | understand that if any statement made by me in this Release is false or if I am otherwise deemed ineligible or unable to accept the Prize for any reason, then, in addition any other remedies that may be taken against me, I agree to return to Sponsor the Prize. |
| (l) | I have been given a full opportunity to review and analyze this Release as well as the promotions in the Official Rules for this Contest. I fully and completely understand all of the terms of this Release and sign it voluntarily, freely, and knowingly. |
| This submission should be sent to via: mail at , , , . |
| By: | Date: |
Sworn to and subscribed before me on this ________ day of __________, 20___
The foregoing instrument was acknowledged before me, by means of ☐ physical presence or ☐ online notarization, this _____ day of ____________________, ______ by _________________________, who is personally known to me or who has produced ________________________________ as identification.
