NASHVILLE, Tenn. (WTVF) — CONTEST/SWEEPSTAKES WINNER AFFIDAVIT OF ELIGIBILITY AND
LIABILITY/PUBLICITY RELEASE
I, _______________________________________ [INSERT NAME OF WINNER], am submitting this Affidavit and Release to Scripps Media, Inc. (the "Promoter") d/b/a station WTVF-TV, 474 James Robertson Parkway, Nashville, TN 37219, (the "Station") with the understanding that it will be relied upon to determine whether I am entitled to receive the prize for which my entry has been selected as a winner in the “Christmas at Gaylord Opryland Sweepstakes” (the "Promotion") conducted by the Station. I understand that the prize I have been selected to receive/win is:
One (1) ‘Christmas Getaway to Gaylord Opryland” certificate good for Two nights accommodations in a single traditional, room (Sun-Thurs only) for winner and up to three guests at Gaylord Opryland Resort , based on availability(ARV: $700); Four admissions to ICE! Featuring Rudolph the Red-Nosed Reindeer (ARV: $144); Four admissions to Ice Tubing (ARV: $91.96); Daily self-parking for one vehicle plus tax included in prize (ARV: $64/$32 per night) (The "Prize").
I represent that I have fully complied with all of the Official Rules of the Promotion, which I have read, and I have committed no fraud or deception in entering or participating in the Promotion or claiming my prize. I further represent that, as of the date I entered this Promotion, and the date of this Affidavit and Release, I was at least 18 years of age and otherwise eligible to participate in accordance with the Official Rules of the Promotion.
In consideration of the Prize, which I acknowledge is good, valuable, and sufficient consideration,
1. I hereby agree to be solely responsible for any and all taxes which may be payable due to my receipt of the Prize, as provided in the Official Rules of the Promotion, and to authorize the Station to withhold any amounts required to be withheld pursuant to Federal, state or local law. I agree to complete and submit an IRS Form W-9 or the equivalent including my full Social Security Number for receipt of any prize valued at $600 or more, or for any prizes awarded to me by the Station in a calendar year with an aggregate value of $600 or more. I further agree that neither the Released Parties, as defined below, nor any other party associated with the Promotion shall have any responsibility for any portion of such tax liability. I further agree that I shall be solely responsible for all costs associated with my use and/or enjoyment of the Prize.
2. I hereby agree not to sue and to release, discharge, indemnify, hold harmless, and absolve the Station, Promoter, its sponsor(s) and promotional partner(s), its advertising and promotion agencies, and each of their respective partners, subsidiary and affiliated entities, and the officers, shareholders, directors, employees, agents and representatives, successors and assigns of each of them (collectively, the “Released Parties”), from any and all claims, demands, actions, suits, losses, expenses, costs, damages and liabilities, including, without limitation, interest, penalties, court costs and attorneys’ fees and expenses (each a “Claim”) of any nature whatsoever which I, my heirs, executors, administrators and assigns, had, now have or may hereafter have against any of them arising out of or in connection with the Promotion or the Prize, including personal injury, death, or damage to or loss of property, which may occur in connection with, preparation for, travel to, or participation in Promotion, or possession, acceptance and/or use or nonuse or misuse of Prize or participation in any Promotion-related activity, including but not limited to any claims based on publicity rights, defamation, or invasion of privacy and merchandise delivery. Nothing herein contained shall in any way limit my recourse against the manufacturer in the event I have any claims as a result of possession or use of the Prize. I also acknowledge that, unless specifically provided for in writing, the Released Parties have neither arranged for, nor carry, any insurance of any kind for my benefit relating to my participation in the Promotion or acceptance or enjoyment of the Prize and that I am solely responsible for obtaining and paying for any such insurance.
3. I hereby acknowledge and agree that the Released Parties are not acting as the manufacturer(s), distributor(s) or travel agent(s) of the Prize. The Station, acting as a consumer, acquired the Prize for the purpose of awarding the Prize to a winner in the Promotion. With respect to any claims I may have as a result of the possession or use of the Prize, I agree that I shall look solely to the Prize's manufacturer or others in the chain of production and distribution of the Prize excluding the Released Parties. I acknowledge that the Released Parties have not made any representations or warranties with respect to the Prize. I also acknowledge that the Released Parties have neither arranged for, nor carry, any insurance of any kind for my benefit relating to my participation in the Promotion or acceptance or enjoyment of the Prize and that I am solely responsible for obtaining and paying for any such insurance.
4. I hereby acknowledge and agree that I shall indemnify, defend, and hold harmless the Released Parties from and against, and reimburse them for, all Claims resulting from: (a) my breach of any representation, warranty, covenant, obligation or other agreement contained in this Affidavit and Release; (b) any failure of myself to comply with any applicable laws, statutes, ordinances or regulations; (c) any act or omission or negligence by me; and/or (d) any Claim for personal injury or property damage or otherwise brought by or on behalf of any third party person, firm or corporation against the Released Parties as a
result of, or in connection with, my acts, omissions, negligence or services as they relate to the Promotion or the Prize, or my enjoyment thereof.
5. I acknowledge and agree that if I do not claim the Prize in person at the Station and if the Prize is mailed or shipped to me, that I will assume the risk of its loss or damage and that the Station is not responsible for the Prize’s safe arrival.
6. I hereby agree to grant to the Released Parties and their agents and assigns, without limitation, and without additional financial or other compensation, the right to use my name, likeness, portrait, recorded voice and biographical material, in order to advertise, promote or publicize the Released Parties, the Promotion and any advertisers and co-sponsors associated with the Promotion and their products and services. I further agree that such uses can be made without any notice to me or my inspection or approval of any material used in connection with such uses.
7. Except where prohibited, I agree that: (1) any and all disputes, claims and causes of action arising out of or connected with the Promotion or any Prize (s) shall be resolved individually, without resort to any form of class action, and exclusively by state or federal courts situated in Milwaukee, WI; (2) any and all claims, judgments and awards shall be limited to actual out-of-pocket costs incurred, but in no event shall such costs include attorneys' fees; and (3) no punitive, incidental, special, consequential or other damages, including, without limitation, lost profits may be awarded (collectively, "Special Damages"). Further, I hereby waive all rights to claim Special Damages and all rights to have such damages multiplied or increased.
8. I hereby agree that if any statement made by me in this Affidavit is false or I otherwise breach this Affidavit and Release, then, in addition to any other remedies that may be taken against me, I agree to forfeit and return the Prize.
9. I understand that the Release contained herein is intended to be as broad and inclusive as permitted by law, and I agree that if any portion of such Release is deemed invalid, the remainder will continue in full force and effect. I further understand that such Release is to be interpreted under the laws of the State or Commonwealth where the Station is located, and I submit to the jurisdiction of the courts within this State or Commonwealth and waive all objections to the jurisdiction or venue of such courts.
10. I have read the foregoing before signing below, and represent and warrant that I fully understand the contents hereof and understand that by making this agreement, I surrender valuable rights and that I do so freely and voluntarily.
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Signature Date
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Print Name of Entrant
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Street Address
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City, State, and ZIP Code
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Telephone Number Date of Birth
If the guest/traveling companion is under the age of 18, or the age of majority in your state of residence, traveling companion’s legal guardian must sign below, acknowledging that they agree to the above on behalf of both the traveling companion and themselves, as appropriate.
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Signature Date
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Print Name of Parent/Guardian
