Winner of the coke studio contest

DECLARATION AND RELEASE FORM

“[Concert series presented by Coke Studio]”

I, the undersigned, have entered the “[Concert series presented by Coke Studio]” promotion (the “Contest”) presented by Aréna du Rocket, Inc. (the “Organizer”), in collaboration with [Coca-Cola] and, provided that I have correctly answered the mathematical skill-testing question above, I have won:

The approximate retail value of the Prize is $52,18 CDN.

I understand that the Prize will be mailed to me by a representative of the Organizer, at the address indicated herein, that I shall accept it as awarded and that I am fully responsible for its future use.

I hereby release the Organizer, its affiliated entities and all their representatives, directors, officers, employees and any person acting of their behalf (collectively the “Club”) of all liabilities which may result from my participation in the Promotion and I accept all risks associated therewith. I therefore waive any claim that may exist now or in the future against the Club for damages, including, without limitation, for any personal injury whatever the cause may be, that I could have incurred or suffered in relation to or as a result of my participation in the Promotion and I understand that this waiver is binding on my heirs and successors.

I hereby further consent to the use, including, without limitation, the reproduction and publication, of images and/or videos (with or without sound, including my voice) taken of me by the Organizer or by any person acting on its behalf.

I hereby grant and assign to the Organizer all rights, titles and interests, forever and throughout the world for all medias and on all platforms currently known and to be developed in the future, in connection with the use and reproduction of my (i) pictures, (ii) image (with or without sound) and (iii) voice. I hereby waive any and all rights that I may have in, and any other rights that may come from my image and the use of it. I hereby represent and warrant that the authorization and assignment herein provided for do not violate the rights of any third party. I agree to indemnify the Club for any and all claim, suit, demand or proceeding, loss, damages and expenses (including any third party claim) related to the use of my image as provided herein. The rights granted herein are free of charge and are exempted from any remuneration present or future. I further recognize that the Club shall have no obligation whatsoever to use the pictures and/or videos taken of me.

I declare that I have carefully read all of the foregoing, understand the contents thereof, and consent thereto willingly.