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Date of Birth (MM/DD/YYYY)*
Parent/Legal Guardian Consent (if required)

If I am signing this Contest Submission on behalf of a child who is under the age of majority in his or her Province or Territory of residence (the "child") in my capacity as parent or legal guardian of such child, each statement in this Contest Submission is also made by me in respect of and on behalf of the child who is participating in the Contest. THIS MEANS THAT I AM ALSO MAKING ALL REPRESENTATIONS AND GIVING ALL RELEASES IN THIS CONTEST SUBMISSION ON MY OWN BEHALF AND ON BEHALF OF THE CHILD.

In addition, I hereby declare that:

a) I am the parent or legal guardian of the child and have the authority to sign this Application on behalf of myself and the child, both being hereafter bound by the terms and conditions hereof;
b) I considered whether participation in the Contest is appropriate for the child, and I consented to the child's participation in the Contest.
c) I take full legal responsibility for permitting the child to participate in the Contest.


This Application is made to the best of my knowledge and belief and is a true and accurate statement of the facts contained herein.


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