Lindt on Ice
Master Class with Tessa & Scott
CONTEST ENTRY FORM / APPLICATION - PRINT THIS FORM AND COMPLETE
*Please complete and submit this entry form and the Contest Declaration to the Lindt Chocolate Shop in New
Westminster. All information is to be filled in completely. Only completed applications with a completed Declaration
will be accepted as an Entry into the Contest. Please ensure your answers are legible.
1. Name of skater (first/last):
2. Age and year of birth of skater:
3. Address:
4. Telephone Number (provide the best # to be reached):
5. Email address (required):
6. Are you a member of a skating club? If so, which one? (Please note: we may contact your skating club to verify
that you meet the minimum skating proficiency in order to be eligible for this Contest)
7. Do you have a skating coach? If so, please provide his/her name and contact (email / phone #). (Please note:
we may contact your skating coach to verify that you meet the minimum skating proficiency in order to be
eligible for this Contest)
8. Which location would you like to attend? Please indicate the city.
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9. Minimum requirement – Please indicate (with a circle / checkmark) which of the following SkateCanada
STARSkate Program preliminary level tests you have passed:
a) Preliminary Test in Free Skate
b) Preliminary Test in Dance
c) Preliminary Test Skills
If you have not passed one of the levels listed above, you are not eligible to participate in this Contest.
Skating level most recently passed? ______________________________________________________
10. Winners will be able to participate in a group off-ice Q&A session with Tessa and Scott. In the space provided
below, please submit 2-3 questions you would like to ask Tessa & Scott if you are selected as a potential
winner.
Prior to signing, please make sure to read the full rules & regulations. Please check the box below to indicate that you
have fully read, understand and agree to the rules & regulations.
Signature of skater:_______________________________________________________________________________
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If skater is under the age of 19:
I, the undersigned, represent that I am the ______________________________ (mother, father, legal guardian) of the
person named above (the “child”) and as such I am full authorized and entitled to sign this entry form on his/her
behalf. I have fully read, understand and agree to the rules & regulations for this Contest. I consent to my child
participating in this Contest.
Signature of parent and/or guardian:____________________________________________________________
Additional Information on the Master Class:
1) Only chosen skaters (winners) will be on and off the ice with Tessa & Scott during the Master Class.
2) Applications will be accepted until store closing on June 21, 2015. All applications MUST be received by this
date and must be submitted to the store. No mail, email or electronic versions will be accepted.
3) The minimum skating requirements MUST be met in order for a skater to be eligible for this Contest.
4) All applicants / parents must read the full rules & regulations provided.
5) A parent can fill in the application for their child, but the child MUST meet the minimum requirements in order
to be considered. One application per child.
6) There will be two (2) sessions in a day divided by skating level. There will be an on & off-ice segment with Tessa
& Scott. Final schedule will be sent to skaters chosen. Skaters chosen will be required to participate fully.
7) Skaters chosen will be notified via phone or email (based on the information provided on the application form)
no later than Sunday June 28th.
8) There will be six (6) Master Class skating clinics across Canada in 2015. If a skater is chosen to participate in one
Master Class session, they will not be eligible to participate in any of the other Master Class sessions in 2015.
9) Family and friends are invited to watch on the day of the Master Class, however only those skaters chosen will
be allowed to be on & off the ice with Tessa & Scott.
10) Addresses of Lindt Chocolate Shop where Contest entry forms and declarations should be submitted can be
found at www.lindtboutique.ca
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DECLARATION OF COMPLIANCE WITH CONTEST RULES and COMPLETE RELEASE and WAIVER OF
CLAIMS (“DECLARATION” OR “EVENT RELEASE”)
LINDT & SPRÜNGLI (CANADA), INC. (the “Sponsor”)
2015 LINDT ON ICE MASTER CLASS WITH TESSA & SCOTT
DECLARATION FOR ALL CONTESTS (the “Contest”)
PRIZE DESCRIPTION: Each Grand Prize consists of participation in a group skating session (minimum one
(1) hour in length) and a group off-ice Q&A session with Tessa Virtue and Scott Moir at the Event in question.
There will be two (2) separate skating sessions at each Event. Each Grand Prize winner will be assigned to
and participate in one (1) of these skating sessions based on their skill level and experience (as determined by
the Sponsor, in its sole discretion). All Grand Prize winners will participate in the off-ice Q&A session with
Tessa and Scott. Each Grand Prize winner will be notified of which session they are assigned to and the timing
of their session close to the Event date. Approximate retail value (ARV) of each Grand Prize is $50.
In the event that I am chosen as a potential winner, in consideration of my receipt of or participation in
any portion of the Grand Prize, I hereby declare, confirm and agree as follows:
1.
I have received, read, understood, complied with and will comply with the Contest Rules (“Rules”),
including without limitation, correctly answering the time limited mathematical skill testing question set
out below without aid or assistance (mechanical or otherwise), and meeting the minimum required level
of skating proficiency (as described in the Rules and the Contest entry form) to fully participate in and
benefit from the Grand Prize;
2.
My receipt or participation in any portion of the Grand Prize and Event is subject to the Rules;
3.
I acknowledge that the Grand Prize is as described in the Rules and agree to accept it as it is awarded
to me. I understand that the Sponsor has the right, in its absolute discretion, to make substitutions of
equivalent kind or value for any reason, including in the event of unavailability of any component of the
Grand Prize;
4.
Neither I, nor any person with whom I am domiciled nor any member of my immediate family, is an
employee, representative or agent of the Sponsor, its partners, affiliates, subsidiaries, marketing or
advertising agencies, suppliers, printers, or distributors or a Contest Judge;
5.
I am a resident of British Columbia, Alberta, Ontario or Nova Scotia and am over the age of majority in
my province of residence, or if I am not over the age of majority, my parent, guardian and/or legal
representative has completed the Contest entry form and signed this Declaration on my behalf;
6.
I consent to the use by the Sponsor of my name, age, city of residence, comments, likeness, voice,
photo(s) and/or image(s) in any media in connection with any promotion or publicity for the Contest or
Sponsor, without any additional compensation or other liability or obligation to either myself or my heirs,
executors, assigns, worldwide administrators or personal representatives and waive my moral rights
therein in favour of the Sponsor as well as any right of privacy, copyright or ownership rights in such
media;
7.
In consideration of my participation in any portion of the Grand Prize, I myself, my family members, kin,
heirs, executors, trustees, administrators, successors and assigns do hereby remise, fully release and
forever discharge, waive and save harmless, protect and fully indemnify the Sponsor, Tessa Virtue,
Scott Moir, Sparks Event Marketing Inc., any Event suppliers (including the skating rink where the
Event takes place), and their partners, associates, employees, servants, agents and representatives
(herein collectively referred to as the “Releasees”) and each of them, from any and all actions, claims,
causes of action, suits, costs, expenses, debts, dues, accounts, bonds, covenants, contracts and
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demands whatsoever in respect of any injury, loss or damage to my person or property, including
without limitation, any claim based on the loss of ability to earn income and claims for death, illness,
injury, delay or cancellation (hereinafter collectively referred to as “Claims”), howsoever caused, by or
arising out of my participation in the Grand Prize or my attendance at the Event premises prior to,
during or subsequent to the Event whether as a spectator or participant, no matter how or by whom
such Claims may have been caused and notwithstanding that such Claims be caused or contributed to
by the fault or negligence of the Releasees;
8.
It is further understood and acknowledged that ice skating presents the risk of serious physical injury,
including the possibility of disfigurement, permanent disability, paralysis or death, and my waiver,
release and agreement of indemnification herein expressly applies to any injury, accident, death,
damage, loss, cost or expense that may be suffered by me in connection with or arising from the Grand
Prize and the Event;
9.
The provisions of this Declaration shall enure to the benefit of the respective heirs, executors,
administrators, legal personal representatives, successors and assigns of the Releasees and shall be
binding upon my heirs, executors, administrators, legal personal representatives, successors and
assigns;
10.
Unless prohibited by law, this Declaration is intended to be as broad and as inclusive as is permitted by
the laws of the Province of Ontario and shall be governed by and interpreted in accordance with the
laws of the Province of Ontario. I irrevocably attorn to the jurisdiction of courts of the Province of
Ontario. In the event that any clause or provision of this Declaration shall be held to be invalid by any
court of competent jurisdiction, the invalidity of such a clause or provision shall not otherwise affect the
remaining provisions of this Declaration and that such provisions shall continue to be enforceable;
11.
I have read the contents of this Declaration and I fully understand and agree to all of its provisions and
acknowledge that in signing below, I am waiving substantial legal rights (on my own behalf and on
behalf of my kin, heirs, executors, trustees, administrators, successors and assigns) including giving up
the right to bring an action in a court of competent jurisdiction against the Releasees. I will maintain a
copy of this Declaration for my records; and
12.
I represent and warrant that I have the legal authority to give and sign this Declaration.
**SKILL TESTING QUESTION:
Multiply:
Add:
Divide by:
Subtract:
My answer is:
________________________________________________
PRINT NAME
______________________________
SIGNATURE
24 x 12
64
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__________
____________________
DATE
___________________________________
EVENT LOCATION
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ADDRESS:__________________________________________ APARTMENT:____________
CITY:___________________________________ PROVINCE:_________________________
POSTAL CODE:____________ TELEPHONE NO.: (
)___________________
MINORS UNDER THE AGE OF MAJORITY: If the individual named above is under the age of majority in
his/her province of residence, his/her parent or legal guardian must also complete and sign the
following:
I, the undersigned, represent that I am the ________________________________(mother, father, legal
guardian) of ____________________________ (the “child”) and as such I am fully authorized and entitled to
execute this Declaration and Complete Release and Waiver of Claims on his/her behalf. I hereby declare,
confirm and agree as follows:
1. I am the parent and/or legal guardian of _______________________.
2. I consent to my child, named above, participating in this Contest.
3. I have read the contents of the above Declaration, completed the skill-testing question and fully
understand and agree to all of the provisions of the above Declaration on behalf of my child.
4. In the event my child is chosen as an eligible Grand Prize winner, I understand that the Grand Prize will
be awarded to me and I consent to having my child participate in the
Event.___________________________________________
NAME of PARENT or LEGAL GUARDIAN (PRINT)
____________________________________________
SIGNATURE of PARENT or LEGAL GUARDIAN
ADDRESS:__________________________________________ APARTMENT:____________
CITY:___________________________________ PROVINCE:_________________________
POSTAL CODE:____________ TELEPHONE NO.: (
)___________________
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Bring this coupon to a Lindt Chocolate Shop to
RECEIVE 25% OFF REGULAR PRICE MERCHANDISE,
10% OFF ALL DISCOUNTED MERCHANDISE.
Visit a Lindt Chocolate Shop
and discover a wide selection of irresistible Lindt chocolates
and gifts at delectable deals.
For a list of all store locations, visit www.lindtboutique.ca
*Offer valid on in-stock merchandise only. Cannot be combined with any other offer. Offer valid at any Lindt Chocolate Shop
location in Canada. Limit one offer per customer. Offer expires May 31, 2015. Maximum discount value of 60%.
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