First Nations Health Authority

First Nations Health Authority

Entry Form: Inspiration Nation video contest

SUBMITTER Information

Last Name / First / Date
First Nation: / Age (on date of submission)
Street Address / Apartment/Unit #
City / Province / Postal Code
Phone / E-mail Address
GUARDIAN INFORMATION (If the Submitter is under 18 years of age, please provide parent or guardian contact information below)
Full Name:
Relationship to the Submitter: (Parent/Guardian)
Daytime Telephone Number: / E-mail Address: ______

VIDEO

Video title (as it appears on YouTube):
Short description of your video:
YouTube video URL:

Agreement

Please circle your response:
I acknowledge that I have read and agree to be bound by the Terms and Conditions set out below and the Interact Video Contest Official Rules* Yes No
* A “No” response will disqualify your entry. A copy of the Official Rules can be obtained from  or at

Signature

Submissions are not considered complete until signed
Signature / Date
Guardian Signature / Date

First Nations Health Authority (“Sponsor”)

Inspiration Nation Contest

I, the Submitter, understand and accept the following terms and conditions:

Terms/Conditions.

a) By submitting an entry, the Submitter warrants and represents that:

(i) he/she is the sole and exclusive owner of the copyrights in the video submission and the copy of the video being submitted to Sponsor, including having the written permission and release, for the use of their likeness, from any individual(s) appearing in the video submitted for consideration in this Promotion, and having the written permission and release, for the use of their likeness, from a parent or legal guardian of all minors depicted in the video submitted for consideration; and

(ii) the video has not been entered in any previous competition or won any previous awards or competitions and is not subject to any lien or encumbrance; and

(iii) Submitter has the full and exclusive right, power and authority to submit the video entry, and to grant the Sponsor the rights to the submission, provided in Section 9(d) below, without further compensation; and

(iv) no rights in the submission have been previously granted to any other person, firm, corporation, or entity.

b) Sponsor reserves the right to disqualify any submission at any time in the event Sponsor determines, in its sole discretion, that the submission is offensive, inappropriate, not in keeping with Sponsor’s image, or that an Entrant has not otherwise complied with these Official Rules, Terms, and Conditions.

c) If the submission contains any material or elements that are not owned by the Submitter and/or that are subject to the rights of third parties, the Entrant is responsible for obtaining, prior to submission of the video, any and all releases and consents necessary to permit the use and exhibition of the submission by Sponsor.

By entering a video in the contest, the Submitter waives all rights the Submitter may have with respect to the video, including all moral rights and rights of personality, publicity or privacy, and the Submitter grants to the Sponsor the unrestricted, royalty-free, perpetual, irrevocable, worldwide licence (but not the obligation) to use, reproduce, communicate, modify and display the video in whole or in part anywhere in the world including on the internet, without any fee or other form of compensation and without further notification or permission, for any purpose including the following:

(a) reproducing, publishing, communicating and displaying some or all of the video as part of the contest or otherwise;

(b) identifying the Submitter by name as the owner of the video;

(c) judging the contest; and

(d) for the Sponsor’s advertising purposes, including to advertise the contest, future contests, and the Sponsor’s products and services.

Use of a video by the Sponsor does not mean or suggest in any way that the Submitter is a winner of the contest or entitled to any prize.

e) In the event of a dispute regarding the identity of the person submitting a submission, the submission will be deemed to be submitted by the person in whose name the email account is registered.

f ) By claiming a prize, Submitter agrees that the Sponsor and its officers, employees, shareholders, affiliates, agents, and advertising and promotional agencies have no liability whatsoever for any injuries, losses, or damages of any kind related to participation in this Promotion, or from acceptance or use/misuse of any prize offered.

g) Acceptance of a prize shall constitute Submitter’s agreement that the Sponsor or its agent(s) may use and/or display the winner’s name, address (city, state only), likeness, biographical information, video entry (and content) and/or prize information, without limitation, for promotional purposes, without further consideration, except where prohibited by law.