C100 & Virgin Radio Winner Release Form

RELEASE FORM

WINNER’S DECLARATION
 
I (Name listed in the form below), residing at the address indicated in the form below, declare that:
 
1. I meet all eligibility requirements and acknowledge I have read, understood and complied with the attached contest rules or thestation’s general contest rules as applicable (the “Rules”), notably in connection with my participation in the Contest and anyacceptance and use of the prize.
 
2.I have reached the age of majority in my place of residence. (If not, the DECLARATION OF THE PARENT OR LEGALGUARDIAN TO A MINOR must be filled out, for contests open to minors.)
 
3.I am not an employee of Bell Media Inc., of its agents, parent, affiliated or related companies, subsidiaries, divisions, prizesponsors, promotional and advertising agencies or of any other entity involved in the development, production, administration, orfulfilment of the applicable Contest (“Contest Parties”), nor am I such employee’s parent, sibling, child or domiciled with suchemployee.
 
4. I am eligible to win the prize offered to me if I can correctly answer the mathematical question in the form below.
 
5.If I correctly answer the above mathematical question, I accept the prize as awarded in accordance with the conditions inherent to its use and the Rules.
 
6.I hereby authorize Bell Media Inc., and any Contest Sponsor where applicable, to broadcast, publish, disseminate and otherwiseuse my name, city/town/village and province/territory of residence, photograph, likeness, sobriquet and voice, in connection withany promotion and/or publicity, and/or for general news, entertainment and/or information purposes at no additional compensation to me, beyond the awarding of or participation in the prize.
 
LIABILITY WAIVER (Please read carefully)
I HEREBY ACCEPT THE PRIZE AS OFFERED AND RELEASE THE CONTEST PARTIES FROM ANY AND ALL LIABILITY OR DAMAGES INCLUDING, WITHOUT LIMITATION, FOR BODILY INJURY OR DEATH ARISING OUT OF MY PARTICIPATION IN THE CONTEST AND/OR MY RECEIPT AND USE OF THE PRIZE. I WAIVE ALL RIGHT TO MAKE ANY CLAIMS WHATSOEVER, INCLUDING TAKING ANY LEGAL PROCEEDINGS, AGAINST THE CONTEST PARTIES WITH RESPECT TO THE SAME. I ACKNOWLEDGE THAT UPON AWARDING OF THE PRIZE, THE OBLIGATIONS TYPICALLY BORNE BY THE PROVIDER OF SERVICES OR GOODS BECOME THAT PROVIDER’S RESPONSIBILITY.
 
I declare that I have carefully read this release, understand its content, and consent to it of my own free will. This release also binds my heirs and successors. IN WITNESS WHEREOF, I have signed at the location specified in the form below.