GCI2011ParentalConsentForm

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Parental Consent Form: Google Code-in Contest

This Parental Consent is between Google Inc. and you, as parent or legal guardian of a child

who would like to be eligible to receive a prize in the Google Code-in Contest. This Contest is

designed to (1) encourage and inspire pre-university students to begin participating in open

source development, (2) help open source projects identify and bring in new contributors,and (3) provide pre-university students interested in computer sciences and other fields

with exposure to real-world software development, including coding work, localization,

documentation, and open source community involvement.

Prizes include participation certificates, T-shirts, cash prizes and a grand prize trip to Google

headquarters in Mountain View, California, USA (accompanied by one parent or legal

guardian). Full context and prize details are provided in the Contest Rules available at http://

code.google.com/opensource/gci/2010-11/rules.html (Contest Rules).

The Contest is open to individual students who are between thirteen years of age and no

older than seventeen years of age on November 21, 2011, who are currently enrolled in a pre-

university, high school or secondary school program, and who have agreed to the Contest

Rules.

What do you need to do?

In order for Google to consider your childs entry into this Contest, you must agree to the terms

and completely fill out all requested information in this Parental Consent. To do this, simply

complete this form below and sign it, to indicate that you agree to the terms of this Parental

Consent and to the Contest Rules and that you understand that you and your child will be bound

by this Parental Consent and the Contest Rules. Fax your completed form to +1-650-214-8031or send a scanned copy to [email protected] by 11:59 P.M. Pacific Time on February

7, 2012. PARTICIPANTS WHO FAIL TO RETURN A SIGNED PARENTAL CONSENT BY

THIS DATE WILL BE INELIGIBLE TO RECEIVE ANY PRIZES. Eligible participants must also

provide the following information: their name, postal address, email address, proof of enrollment

in school, including home schooling, and T-shirt size upon entry. This information will be solely

used for the purposes of administering this Contest.

Your Consent

By signing this Parental Consent, you agree to the following terms and conditions:

(1) You, as parent and legal guardian of your child understand and permit your child to

participate in the Contest described in the Contest Rules. Further, you and your child agree to

be bound by the Contest Rules and the terms of this Parental Consent. You and your child have

not and will not perpetrate any fraud or deception in entering this Contest or in claiming any

prize.
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(2) You warrant and represent that you are the age of or above the age of majority in your state,

country, province, or jurisdiction of residence and that you have every right to contract in your

own name and in the name of your child. You warrant that your child was and is eligible under

the Contest Rules.

(3) If your child is selected as a winner during the initial round of judging, you understand thatyour child, accompanied by one parent or legal guardian, will be asked to travel to Mountain

View, California, on or about June 1, 2012 under the terms set out in the Contest Rules.

(4) You also agree that, if your child is selected, Google have the right to use his or her first

name and likeness in any promotion or marketing related to the Contest, without further

compensation to you. You grant Google the worldwide, unrestricted, absolute, royalty free,

perpetual and irrevocable right to:

A. To use, re-use, duplicate, publicly perform, publicly display, create a derivative work

from, modify, publish and re-publish any work of publicity (work) that may contain a property

owned by you or your child, or your or your childs name, image, persona, voice, likeness or any

other recognizable feature of you or your child, in whole or in part, severally or in conjunction

with other photographs, statements, film or recordings, in any medium and for any purpose

whatsoever, including, but not limited to, illustration, promotion and advertising, and trade; and

B. To use your or your childs name, image, persona, voice, likeness or any other

recognizable feature of you or your child in connection with the Contest or your childs

submission to the Contest if they so choose.

(5) Privacy Disclaimer: Any personal information collected by Google during the course of the

Google Code-in Contest will only be used for administering this competition, or as otherwise setout in the Contest Rules.

(6) Release. IT IS UNDERSTOOD AND AGREED THAT THIS IS A COMPLETE RELEASE

AND DISCHARGE OF ANY AND ALL CLAIMS, ACTIONS AND DEMANDS OF THE

UNDERSIGNED AGAINST GOOGLE, ITS AFFILIATES, PARENT, AND SUBSIDIARY

COMPANIES, ITS EMPLOYEES, AGENTS AND OFFICERS, ADVERTISING AND

PROMOTION AGENCIES, ARISING OUT OF OR IN CONNECTION WITH THE USE

OF THE PRIZE, WORK OR PROMOTION AND THAT NO ACTION WILL BE TAKEN BY

OR ON BEHALF OF THE UNDERSIGNED WITH RESPECT TO ANY SUCH RIGHTS, IT

BEING UNDERSTOOD THAT THIS RELEASE SHALL BE BINDING UPON THE HEIRS,

EXECUTORS, AND ADMINISTRATORS OF THE UNDERSIGNED. THIS AUTHORIZATION

AND RELEASE SHALL ENURE TO THE BENEFIT OF THE LEGAL REPRESENTATIVE,

LICENSEES AND ASSIGNS OF GOOGLE.

I, ____________________________________, understand that the conditions as listed above

(parent or legal guardians name)


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and give my consent that _________________________________ is eligible to participate in

(childs name)

Google Code-in Contest and has my consent to participate in the Google Code-In Contest and

to provide the information necessary for prizes to be awarded.

_______________________________ _______________________

Parent or Legal Guardians Signature Date

Any questions regarding this signed Parental Consent can be directed to the above-signed at:

Full written name(s) of parent(s)/legal guardian(s): ________________________________

Mailing Address: _____________________________________________________________

City/State/Country: ___________________________________________________________

Telephone number(s): _________________________________________________________

Email address: _______________________________________________________________

GCI2011ParentalConsentForm

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