Winners Affidavit of Eligibility and Release
October 2003 Competition
INSTRUCTIONS: Winners
must fill out this document so that ThinkQuest can confirm
your eligibility as a winner of the ThinkQuest Competition.
Please read the document and fill out the places where you
are asked for information. At the end of the document you
will see a place for your signature (and/or your parent's
signature). You will also see an area that needs to be
filled out and signed by a Notary Public, an Apostille or
the equivalent official within your country. The Notary Public,
Apostille or equivalent official in your country will certify
that your signature is valid. This step must be completed
for you to submit this affidavit and accept your prize.
We
recommend making a copy of the completed form for your
records. Please mail the original, signed form to the
address to the right. Please
also consider using a mailing service that is trackable,
such as registered/certified mail or UPS/DHL/FedEx.
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ThinkQuest
c/o Oracle Education Foundation
500 Oracle Parkway M/S LGN-2
Redwood Shores, CA 94065
United States of America |
I, ________________,
hereby submit this Affidavit of Eligibility and Release under
oath to ThinkQuest Judges, official judges in the ThinkQuest
Competition (the "Competition") sponsored by The
Oracle Education Foundation
(the "Sponsor"). I understand that it will be relied
upon to determine my eligibility to receive the winning prize
(the "Prize") in the Competition. Each winning team
member (primary and assistant coaches, students, and one parent
per student) will be eligible to attend a trip to ThinkQuest
Live in San Francisco, CA USA. This trip to San Francisco
is valued at approximately $4,000 USD per winning team member.
In consideration of receiving the Prize, I hereby agree and
acknowledge that:
1.
(a) To be completed by the Member of the Winning Team
(student or coach):
Date
of Birth _______________________
I am a resident of the State/Province of ___________ and
reside at
(Street Address) ______________________________
(City/State/Zip/PostalCode)
____________________
(Country) ___________________________________
(Citizenship) ________________________________
(Telephone Number) __________________________
My
Social Security (or other identifying) Number is __________
(b)
If the above is a student who will be traveling with a parent/guardian
chaperone, to be completed by the parent/guardian chaperone
who will attend:
[ ] Check here if this section is not applicable.
Name
_________________________________
Date
of Birth _______________________
I am a resident of the State/Province of ___________ and
reside at
(Street Address) ______________________________
(City/State/Zip/PostalCode)
____________________
(Country) ___________________________________
(Citizenship) ________________________________
(Telephone Number) __________________________
My
Social Security (or other identifying) Number
is __________
2.
I understand that the Prize is being awarded to me subject
to applicable law and to all terms, conditions and restrictions
relating to the Prize imposed by Sponsor. I have complied
with all the rules and regulations applicable to the Competition.
I have committed no fraud or deception participating in
the Competition or claiming the Prize. I, the members
of my immediate family and those living in my household
are employed as follows:
(a)
To be completed by the winning team member (student or coach):
| Name |
Employer |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
(b)
If the above is a student who will be traveling with a parent/guardian
chaperone, to be completed by the parent/guardian chaperone
who will attend:
[ ] Check here if the information for this section
is the same as the information listed above.
| Name |
Employer |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
| _____________________ |
_____________________ |
3. I
understand that I will be solely responsible for all federal,
state, VAT, withholding, municipal or other governmental taxes,
duties, licenses, fees, excises or tariffs now or hereafter
imposed and other costs I may incur in connection with my
participation in the Competition and my receipt of the Prize.
4. I,
for myself, and my heirs, administrators and successors, hereby
release Sponsor, its parent corporation, and each of their
directors, employees, shareholders, members, officers and
agents, including without limitation its advertising and promotion
agencies (all together called the "Sponsor Group") from any
and all liability, claims or causes of action which may arise
out of or in connection with my participation in the Competition
or my receipt of the Prize. I, for myself, and my heirs,
administrators and successors, hereby agree to indemnify and
hold the Sponsor Group harmless from any and all liability,
loss, damage, cost or expense of any nature whatsoever (other
than costs of the Prize expressly assumed by Sponsor), including
all reasonable attorneys' fees and court costs, incurred by
the Sponsor Group as a result of actions taken by me in connection
with my participation in the Competition and/or my receipt
of the Prize.
5. (a)
Without additional compensation, I hereby grant Sponsor permission
to use my name, voice, likeness and biographical material
about me in connection with the advertising and promotion
of its products, for both broadcast and nonbroadcast purposes
in all media, in such manner and at such times as Sponsor
in its sole discretion, may deem appropriate or desirable,
provided that such use relates to my status as a participant
in the Competition and/or a recipient of the Prize.
I hereby waive all right of inspection and release Sponsor
from any and all liability arising out of any such use of
my name, voice, and likeness and/or biographical material
about me. I further agree that the timing of any public
announcement and all other publicity relating to my participation
in the Competition and/or my receipt or use of the Prize will
be subject to Sponsor’s approval and, to that end, I agree
not to discuss with the media, publicize or otherwise disclose
to any third party any information whatsoever relating to
my participation in the Competition and/or receipt of the
Prize without the express prior written approval of a duly
authorized representative of Sponsor.
(b)
Pursuant to Section VIII(b) of the ThinkQuest Entry Submission
Agreement, upon
submission, I understand that my entry (Entry) shall become
the exclusive property of the Sponsor, and I shall and hereby
do assign to the Sponsor all of my right, title, and interest
in and to any Entry content, including without limitation,
all concepts, know-how, techniques, ideas or materials comprising
or included in my Entry without any restrictions, liability,
or accounting to me or any third party, except to the extent
the Entry comprises materials or intellectual property rights
owned by third parties (Third Party Materials). To the
extent the Entry includes any Third Party Materials, I hereby
grant the Sponsor an irrevocable, fully-paid up, perpetual,
transferable, fully-sublicensable, exclusive right and license
to use such Third Party Materials, solely as embodied in the
Entry.
6. If
any statement made by me in this Affidavit is false or misleading,
I will immediately return to Sponsor upon demand a cash amount
equal to the fair market value of the Prize on the date hereof.
7. This
Affidavit of Eligibility and Release is to be governed by
the internal laws of the State of California and the United
States of America. I hereby (1) waive all right to trial by
jury; (2) consent to the exclusive jurisdiction of the Supreme
Court of the State of California and of the United States
District Court for the San Mateo County District of California;
and (3) consent that any process of notice of motion or other
application to the court or judge thereof may be served within
or without the State of California by registered or certified
mail, or by personal service, provided a reasonable time for
appearance is allowed. The United Nations Convention
on Contracts for the International Sale of Goods shall not
apply to the Agreement.
8. The
parties confirm that this Affidavit and all related documentation
will be drafted in English. Les parties aux présentés
confirment leur volonté que cette convention de même que tous
les documents y compris tout avis qui s’y rattaché, soient
redigés en langue anglaise. The original and controlling
version of this Affidavit shall be the version using the English
language. All translations of this Affidavit into other languages
shall be for the convenience of the parties only, and shall
not control the meaning or application of this Affidavit.
All notices and other communications required or permitted
by this Affidavit must be in English, and the interpretation
and application of such notices and other communications shall
be based solely on the English language version thereof. La
version originale et controllante de cette Attestation et
la version Anglaise. Toutes les traductions de cette
Attestation dans une autre langue est uniquement pour le bénéfice
des parties et ne sera pas contollant du sens de l'Attestation.
Touts les avis et communications requis ou permis part cette
Attestation doivent etre dans la langue Anglaise et touts
les interpretations et les applications de ces communications
sera dans la langue Anglaise.
PLEASE
TAKE THIS DOCUMENT TO EITHER A NOTARY PUBLIC, AN APOSTILLE
OR THE EQUIVALENT OFFICIAL IN YOUR COUNTRY AND SIGN THE DOCUMENT
IN THE PRESENCE OF THAT PERSON. THE NOTARY PUBLIC, APOSTILLE,
OR OTHER OFFICIAL IN YOUR COUNTRY WILL THEN SIGN AND STAMP
THE APPROPRIATE PAGE TO CERTIFY YOUR SIGNATURE.
_______________________________________
Signature
of the Member of the Winning Team (student or coach)
_______________________________________
If the
above is a student who will be traveling with a parent/guardian
chaperone, signature of the Parent/Guardian who will attend
If Participant
has not reached the age of majority in his/her state or province
of residence, his/her custodial parent or legal guardian hereby
agrees to and acknowledges the foregoing on behalf of him/herself
and the Participant.
________________________________
Signature
of Custodial Parent or Legal Guardian
________________________________
Print
Name of Custodial Parent or Legal Guardian
______________________
Date
NOTARY
PUBLIC
State/Province
of ___________)
County/
of ___________) ss.
__________________________
appeared
before me this day in person and acknowledged the foregoing
Affidavit of Eligibility and Release to be his/her free act
and deed this ______ day of _____________________ , 20_____.
___________________________________
Notary
Public
My commission
expires: ______________
APOSTILLE
Country:
___________________________________
This
public document has been signed by:
____________________________________________
acting
in the capacity of: _______________________
bears
the seal/stamp of: _______________________
CERTIFIED
at:
__________________________________
the:
_________________________________
by:
__________________________________
No.:
_________________________________
Seal/Stamp
Signature:
_____________________________
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