Aulani, a Disney Resort and Spa Ellen DeGeneres Show s 12 Days of Giveaways Statement of Eligibility and Release

Transcription

1 Aulani, a Disney Resort and Spa Ellen DeGeneres Show s 12 Days of Giveaways Statement of Eligibility and Release Disney Destinations, LLC ( Prize Supplier ) is supplying the Prize (described below) pursuant to a prize voucher distributed in connection with the 12 Days of Giveaways ( Promotion ) on the Ellen DeGeneres Show ( Sponsor ). This Statement of Eligibility and Release ( Statement & Release ) will be used by Prize Logic, LLC ( PrizeLogic ) to verify my eligibility to receive the Prize. The Approximate Retail Value of the Prize is $2,396. I, (print complete name), hereby state as follows: I am submitting this Statement & Release at the Prize Supplier s request and to comply with the requirements of the Voucher provided to me by Sponsor and the rules for receipt of the Prize. I recognize that this Statement & Release hereby serves as confirmation to Prize Supplier that I am a Prize winner in the Promotion. I understand that I must sign this Statement & Release and return it to PrizeLogic. Further, I agree that the signed Statement & Release must be received by PrizeLogic prior to travel (or, if I have already traveled, no later than ten (10) business days from the date I received this Statement & Release) or the Prize may be forfeited. I will send the signed Statement & Release within such time to: PrizeLogic ATTN: Fulfillment Operations Telegraph Road, Suite #405 Southfield, MI Fax #: (480) I understand that the Prize I will receive is a Vacation Package, which includes room accommodations consisting of one (1) standard room (with a maximum of four (4) persons per room) for four (4) nights and one (1) $500 non-transferable resort credit that will expire upon my departure. All Stays must be completed by December 18, No stays (or any portion thereof) shall be permitted during the following periods: February 7, 2016 through February 20, 2016; March 6, 2016 through April 2, 2016; June 26, 2016 through August 8, 2016; November 18, 2016 through November 22, 2016; December 20, 2016 through January 1, 2017; February 12, 2017 through February 25, 2017; March 12, 2017 through April 16, 2017; June 25, 2017 through August 5, 2017; and November 19, 2017 through November 21, 2017 Vacation Package is not combinable with any other package or offer. No Prize substitution or exchange will be allowed. I further understand and agree that all costs and expenses not expressly listed in the Vacation Package described above shall be solely my responsibility, including without limitation transportation, parking, meals, excursions, laundry service, spa treatments, alcoholic beverages, telephone calls, merchandise, souvenirs, incidental expenses and tips. I understand and acknowledge that the Prize is subject to all of the terms, conditions, and restrictions set forth by the Prize Supplier.

2 I understand that I must present my original Voucher with my name on it and a valid state or federal government issued photo ID at check-in in order to receive the Prize. I represent and warrant that I am the original Voucher recipient and have not committed, nor been party to, nor had knowledge of the commission of any fraud, deception, or misrepresentation in connection with my receipt of the Prize. I further represent and warrant that I am at least eighteen (18) years of age and the age of majority in my jurisdiction of residence and that I am a legal United States resident physically residing in one of the fifty United States or District of Columbia. I represent and warrant that all of the information I have provided and will provide in connection with this Promotion has been and will be true, accurate and complete. If any statement made by me in this Statement & Release is false, then, in addition to any other remedies that may be taken against me, I agree to return to the Prize Supplier any prize awarded to me. Release of Liability In further consideration of my receipt of the Prize, on behalf of myself, my heirs, executors, administrators and assignees, I hereby release and hold harmless Prize Supplier, Sponsor and PrizeLogic and each of their respective parent, subsidiary and affiliated entities (collectively, Promotion Entities ) and each of their respective officers, directors, employees, representatives and agents (together with the Promotion Entities, the Indemnified Parties ) from all liability and responsibility for any and all claims, damages, losses and liabilities of any nature whatsoever that I or any of the aforementioned parties may now or hereafter be entitled to assert, including, but not limited to any death, property damage, injury, loss of enjoyment or other harm or loss of any nature whatsoever caused or arising out of my participation in the Promotion and/or acceptance, use, or misuse of the Prize. I also acknowledge that the Promotion Entities have neither arranged for nor carry any insurance of any kind for either me or any of the aforementioned parties benefit relating to my acceptance and/or participation and enjoyment in any aspect of the Prize and that I am solely responsible for obtaining and paying for any such insurance. I voluntarily accept the Prize awarded to me with the knowledge of all risks of acceptance. I accept, at my own risk, and take sole and absolute responsibility for any injuries arising or damages incurred out of the use, misuse, or acceptance of the Prize, including, without limitation, the risk of personal injury or death, and I shall not hold the Promotion Entities responsible. Further, I agree to waive all of rights to bring any claim, action or proceeding against any of the Indemnified Parties in connection with the Promotion. I hereby expressly accept the Prize with the full knowledge and understanding that all applicable federal, state, and local income or other taxes resulting from my acceptance of the Prize shall be solely my responsibility, and that none of the Promotion Entities shall have any responsibility for any portion of such tax liability. Further, I understand and acknowledge that I will be issued a form 1099 for tax purposes in the amount of the actual retail value of the Prize, and I must submit my Social Security Number or taxpayer identification number, as required by law. The provisions of this Statement & Release shall be governed by and constructed in accordance with the laws of the State of Hawaii excluding its conflict of laws principles. I hereby irrevocably submit to the jurisdiction and venue of a court of competent jurisdiction located on the Island of O ahu, Hawaii.

3 I do hereby state and acknowledge that by signing below I understand and agree to be legally bound by all of the statements, terms, and conditions contained herein. (Please Initial) I acknowledge I will receive a federal tax form 1099 stating the actual retail value of the Prize. Winner s Complete Legal Name (Please Print) Winner s Address Winner s Social Security Number Winner s Phone Number(s) Winner s Date of Birth (MM/DD/YYYY) Home Address (Street Address, City, State, ZIP) Cell: Home: Winner s Signature Date

4 Aulani, a Disney Resort and Spa Ellen DeGeneres Show s 12 Days of Giveaways TRAVEL COMPANION RELEASE I, (print complete name), hereby state as follows: I have been selected by (Insert Name of Winner), a Prize Winner in the 12 Days of Giveaways ( Promotion ) on the Ellen DeGeneres Show ( Sponsor ) to be a guest to participate and enjoy in the travel aspects of the trip portion of the Prize. I submit this Travel Companion Release ("Statement & Release") to Prize Logic, LLC ( PrizeLogic ) on behalf of Disney Destinations, LLC ( Prize Supplier ), to verify my eligibility to be the Prize Winner s travel companion. In consideration of my being the Prize Winner's travel companion, on behalf of myself, my heirs, executors, administrators, and assignees, I hereby release and hold harmless Prize Supplier, Sponsor and PrizeLogic, each of their respective parent, subsidiary and affiliated entities (collectively, Promotion Entities ) and each of their respective officers, directors, employees, representatives and agents (together with the Promotion Entities, the Indemnified Parties ) from and against all claims, damages, losses, and liabilities of any nature whatsoever that I or any of the aforementioned parties may now or hereafter be entitled to assert, including, but not limited to, any death, property damage, injury, loss of enjoyment, or other harm or loss of any nature whatsoever caused by or arising out of my participation in the Promotion and participation in the Prize. I also acknowledge that the Promotion Entities have neither arranged for nor carry any insurance of any kind for either my benefit or the benefit, of any of the aforementioned parties, relating to my acceptance, participation, travel, attendance, enjoyment, and/or use or misuse of any aspect of the Prize, and that I am solely responsible for obtaining and paying for any such insurance. Further, I agree to waive all of rights to bring any claim, action or proceeding against any of the Indemnified Parties in connection with the Promotion. I also acknowledge that I am solely responsible for obtaining identification documents necessary for travel. I also understand that Sponsor will not replace any lost, mutilated, or stolen tickets, travel vouchers, or certificates. The provisions of this Statement & Release shall be governed by and constructed in accordance with the laws of the State of Hawaii excluding its conflict of laws principles. I hereby irrevocably submit to the jurisdiction and venue of a court of competent jurisdiction located on the Island of O ahu, Hawaii. I warrant and represent that I have the full right and power to enter into this Statement & Release, and that the terms of this document do not in any way conflict with any existing commitment on my part.

5 I declare that I am over eighteen (18) years old and the age of majority in my jurisdiction of residence or that I have my parent or guardian s consent as indicated by his/her signature below. I have read this Statement & Release, I understand its contents, and I intend to be legally bound hereby. I have received good and valuable consideration for this waiver and release. My Legal Name My Address My Phone Number(s) Cell: Home: Date of Birth (MM/DD/YYYY) Home Address (Street Address, City, State, ZIP) Signature Date: If the subject is a minor: I declare that I am the parent or guardian of the minor child whose name is set forth above and hereby confirm the signature of my minor child and consent to the rights and obligations set forth above. Parent/Guardian Signature of Minor Child: