Languages Build Video Contest

Consent Form

"*" indicates required fields

Entrant's Contact Information

Name*

First Name Last Name

Date of Birth*

Email Address*

Enter Email Confirm Email

Address*

Address Line 1 Address Line 2 City Province/Territory Postal Code

Phone Number*

Would you like to send a copy of this form to someone else (e.g., your teacher)?*

Yes

Enter that person’s email address here*

Consent and Release*

I, the undersigned, have read, understand, and agree to abide by the rules governing the contest (as set out in the Languages Build Video Contest Descriptions) and certify that all information contained in this Form is true and accurate. By signing this Form, I irrevocably grant the Canadian Association of Second Language Teachers (the “Contest organizers”) (as defined in Languages Build Video Contest Rules) the right and permission to:

(1) publicly disclose and use my name, address, likeness, school, age, grade and/or prize information for promotional or other purposes, without compensation; and

(2) copy, modify, play, and use the submitted video (the “Video”), accompanying this Form in whole or in part, without compensation.

The Video has been originally and lawfully created by me or my group and the use, modification, play or reproduction of the Video by the Contest Organizers will not give rise to any third-party claims for infringement or violation of copyright, trademark or any other right of any third party, or to any third-party claims including libel, defamation, violation of privacy or contract breach. I have obtained all necessary permissions, consents, licenses, or other approvals of third parties (including, but not limited to, all individuals appearing in the Video and all holders of copyright in any copyrighted music, images or other materials used in the Video) necessary or appropriate for the preparation or use of the Video.

I further agree to waive any and all moral rights in the Video and further agree that all rights to the Video entry or other submissions, including copyright in and to the Video, are hereby irrevocably assigned to the Contest Organizers, to be used by the Contest Organizers for any purpose it deems appropriate.

I release the Contest Organizers from any liability in connection with my participation in this contest, or the preparation or use of my or my group’s Video and agree to indemnify the Contest Organizers for any liability and all reasonable costs arising from any third-party action, claim or proceeding commenced against the Contest Organizers because of the Video.

I have read, understand, and agree to the consent and release.

Confirmation of Entrant’s Age*

Note: This question refers to the age of the contest participant (not of a parent/guardian who may be completing this form on a child’s behalf).

I am 18 years of age or older

I am under 18 years of age

Consent of Parent or Guardian

(Required if student signing above is a minor, i.e., under 18 years of age)

Parent/Guardian Name*

First Name Last Name

Parent/Guardian Email Address*

Enter Email Confirm Email

Parent/Guardian Phone Number*

Phone

This field is for validation purposes and should be left unchanged.

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Languages Build Video Contest

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