Applicant Information Name: _____________________________________________________________ Age: ____________________________________________________________ ___ Address: ____________________ ________________________________________ ____________________________________________________________________ County (circle one): Phone Number: ( Oakland ) Macomb Wayne -__________ School Email: _________________________________________________________ Twitter handle @___________________________ Education Information School: ______________________________________________________________ School Address: ____________________________________________________ __ ___________________________________________________________________ _ Major (if applicable): _________________________________________________ _ Grade/Year: ________________________________________________ _________ School Twitter handle: @______________________________________________ _ Teacher Sponsor Name: _______________________________________________ _ Teacher Sponsor Email: _______________________________________________ _ Please submit all forms via email, fax or mail by Thursday, June 4 Email scholarship@cobocenter.com or fax to Kristin Shaw (313.877.8800) with subject line “30/60 Video Scholarship” or mail to Kristin Shaw, Cobo Center, 1 Washington Boulevard, Detroit, MI 48226 Cobo Center 30/60 Video Scholarship Release Statement CONDITIONS OF PARTICIPATION: By participating in this scholarship challenge, applicant (and applicant's parent or legal guardian if Submitter is a minor) agree (and agree to confirm in writing) (a) to release Cobo Center from any and all claims, damages or liabilities arising from or relating to such applicant's participation in the scholarship challenge; and (b) applicants waive all rights to claim, punitive, incidental, consequential, or any other damages. If a finalist/winner is found to be ineligible or not in compliance with these Official Rules, the scholarships(s) may be forfeited and an alternate winner may be selected. Submissions cannot defame, misrepresent or contain disparaging remarks about Detroit, Cobo Center or its services, products, or people. Cobo Center reserves the right to and will, monitor or screen submissions. By providing a submission, you agree that your submission may be posted on Cobo Center-related websites, social media channels, internal and external communication, in Cobo Center's sole discretion. Cobo Center has no obligation to use or post any submission you submit. By providing a submission, the applicant grants to Cobo Center, an exclusive, perpetual, transferable license to copy, publish, broadcast, display, distribute, use, edit, translate, alter, combine with other material, reuse and adapt any or all portions of the submissions in any way and for any purpose whatsoever, at any time, now or in the future, in any media now known or hereafter devised throughout the world in any manner whatsoever and for any purpose. Submissions that are not in accordance with the guidelines as stated herein or are not received during the contest submission period will be ineligible. Submissions cannot (a) be sexually explicit or suggestive, violent or derogatory of any ethnic, racial, gender, religious, professional or age group, profane or pornographic, contain nudity or any materially dangerous activity; (b) promote alcohol, illegal drugs, tobacco, firearms/weapons (or the use of any of the foregoing), any activities that may appear unsafe or dangerous, or any particular political agenda or message; (c) be obscene or offensive, endorse any form of hate or hate group; (d) contain trademarks, logos or trade dress owned by others, or advertise or promote any brand or product of any kind without permission, or contain any personal identification, such as license plate numbers, personal names, email addresses or street addresses without permission; (e) contain copyrighted materials owned by third parties other than the applicant (f) contain materials embodying the names, likenesses, photographs, or other indicia identifying any person, living or dead, without permission; and (g) depict, and cannot itself be in, a violation of any law. By submitting a submission you warrant and represent that it: (a) is your team's original work, (b) has not been previously published, (c) has not received previous awards, (d) does not infringe upon the copyrights, trademarks, rights of privacy, publicity or other intellectual property or other rights of any person or entity; (e) that you/your team have obtained permission from a person who is used in the submission or whose name, likeness or voice is used in the submission, if any, and (f) that publication of the submission via various media including online posting, will not infringe on the rights of any third party rights. Any such submitter will indemnify and hold harmless Cobo Center. Any applicant whose submission includes likenesses of third parties or contains elements not owned by the applicant (such as, but not limited to, depictions of persons, buildings, trademarks or logos) must be able to provide legal releases for such use Any submission that, in the sole opinion of Cobo Center, is deemed to be inappropriate for publication is ineligible. Incomplete, illegible, false, deceptive or garbled submissions are not eligible. All submissions become the sole property of Cobo Center, and will not be acknowledged or returned. By submitting a submission, you agree that your submission is gratuitous and made without restriction, and will not place Cobo Center under any obligation that Cobo Center is free to disclose or otherwise disclose the ideas contained in the submission on a non-confidential basis to anyone or otherwise use the ideas without any additional compensation to you. You acknowledge that, by acceptance of your submission, Cobo Center does not waive any rights to use similar or related ideas previously known to Cobo Center, or developed by its employees, or obtained from sources other than you. ____________________________________ _ Name of Applicant ____________________ Date ____________________________________ Signature of Applicant If under 18, the following statement must ALSO be signed by applicant’s parent/legal guardian. I am the parent or legal guardian of the applicant. By submitting this video entry form, I represent that I understand the Release Statement governing this contest and agree to be bound by it. ____________________________________ Name of Applicant’s Parent/Legal Guardian _ ____________________________________ _ Signature of Applicant’s Parent/Legal Guardian ____________________ Date Cobo Center 30/60 Video Scholarship Talent Permission Form I consent to the videotaping/photographing of myself and the recording of my voice. I consent to the use of these video images/photographs and/or recordings by themselves or in conjunction with other video images/photographs and/or recordings for advertising, publicity, or other business purposes. I further consent to the reproduction and use of these items. I release Cobo Center, its employees and vendors from all claims of every kind based on such use. _________________________________ Model's Printed Name _____________________________________ Model's Signature If model is under 18 years of age: I, _______________________, am the parent/legal guardian of the individual named above, have read this release and approve of its terms. ______________________________ Parent/Guardian Print Name _______________________________ Parent/Guardian Signature ____________________ Date This signed consent form must be submitted for everyone appearing in a Cobo 30/60 Video Scholarship challenge entry. Email questions to scholarship@cobocenter.com
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