It is understood and agreed that 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 affidavit and release shall be binding upon the parents or guardians of a
minor winner, and the heirs, executors, and administrators of the undersigned.
ENTRANT
INFORMATION
________________________________________
___________________________________________
Full Printed Name
Signature
________________________________________
___________________________________________
Street Address
(P.O. Box not acceptable)
Date Of Birth
(must be 14 years or older as of date of entry)
________________________________________
City, State & Zip
________________________________________
Daytime Phone Number
PARENT
OR
GUARDIAN
MUST
COMPLETE
THIS
SECTION
IF
ENTRANT
IS
A MINOR
IN
THE
JURISDICTION
IN
WHICH
HE
OR
SHE
RESIDES:
I, _____________________________________, being the parent or adult legal guardian of ___________________
__________________________, do hereby consent and grant my permission to all of the foregoing and I personally
join in the warranties, representations and agreements set forth above. I also agree to indemnify and hold harmless
the Releasees with respect to any claims which my child or ward may make as a result of the exercise by the
Releasees of their rights hereunder.
Full Name Printed
Signature of the Parent or Legal Guardian
Date Of Birth
Email Address
(if available)
Parent or Legal Guardian daytime phone number
