Name
Phone
Email
Address 1
Address 2
City
Province
Postal Code

IMPORTANT: If you are selected as a potential winner for a Grand Prize Draw, you must have read and accepted this Declaration and Release Statement, by checking the box at the bottom of this page, before you are declared a winner.

By acknowledging this Declaration and Release Statement, I hereby declare, confirm and agree:

• I have read, understand and complied with the official rules and regulations of the Contest. I understand my receipt of/participation in the prize is subject to the Full Official Contest Rules
• I am a legal resident of Canada and had reached the age of majority in the province where I reside on the day I entered the contest.
• I did correctly answer a mathematical skill-testing question without any aid
• Neither I nor any member of my immediate family is employed by Campbell or any of its divisions, subsidiaries, affiliates, or promotional agencies; or by any of the Contest Parties as defined in the Official Rules.
• I consent to the use of my name, address (city and province/territory) and/or photograph without further notice or remuneration, in connection with any publicity carried out by or on behalf of Campbell in connection with the Contest.
• I will accept the Prize as awarded. I understand that I am solely responsible for payment of any applicable taxes and reporting any taxable income associated with my prize, if applicable under local tax law in the province in which I reside.
• I fully release, indemnify and forever discharge Campbell and its respective agents, affiliates, subsidiaries, partners, partnerships, principals, owners, representatives, contractors, sub-contractors, consultants, advertising and promotional agencies, and each of their respective officers, directors, shareholders and employees (hereinafter collectively referred to as the (“Releasees”) from, and waive as against the Releasees, all recourses, loss or damages including any consequential loss or damages, actions, causes of action, suits, debts, dues, accounts, bonds, covenants, contracts, claims and demands whatsoever, including without limitation, any claim based on the loss of ability to earn income, claims for injury, death, illness, delay or cancellation (hereinafter collectively referred to as (“Claims”), which I, my heirs, executors, administrators or personal representatives now have or hereafter can, shall or may for or by reason of or in any way howsoever arising out of the Contest and my receipt of the Prize awarded pursuant to the Contest, including, without limitation, any Claims arising out of the subsequent use of the Prize, whether such use is by me or by anyone else acting with or without my knowledge and/or consent.
• I represent and warrant that I have the legal authority to give this Declaration and Release