Victims and Survivors of Crime Week
Student Video Competition Award Submission Form

Complete Mailing Address (required)

I hereby acknowledge that in return for the right to participate in the Victims Week Student Video Competition Award, I agree to be bound by the following terms.

I have read and understood the Victims Week Student Video Competition Award Guidelines, including the Privacy Notice.

I represent and warrant that:

• I have reached the age of majority in my province or territory of residence
• The video and transcript (the Work) that I am submitting is my original Work, or the original Work of my collaborators and I
• I have the authority to grant the rights granted herein
• I have not infringed any third party rights, including third party intellectual property rights in creating and submitting this Work
• I have sought the written consent of any individual appearing in my/our Work or if any such individual is under the age of majority that I have obtained the written consent of their parent or guardian, and agree to provide a copy of such consent upon Justice Canada’s request

I hereby confirm that I am in agreement with the choice of Team Captain, as identified below:

I hereby grant His Majesty the King in right of Canada as represented by the Minister of Justice (Justice Canada) a non-exclusive, royalty-free right to use, reproduce, stream, broadcast, edit, translate, adapt, or otherwise disseminate my/our Work, without any further approval from me, in whole or in part, throughout the world, in perpetuity, in any and all media now known or hereafter developed, including the Internet for purposes related to the Victims Week initiative and for related departmental non-commercial purposes. This grant includes, but is not limited to, the right to use the Work either alone or together with such information as my name, the name of my collaborators, my image, likeness, voice and biographical data (collectively, “Supporting Information”). Examples of permitted uses of the Work and Supporting Information include adding the Work to a YouTube playlist, displaying or streaming the video at the virtual Victims Week event, or any event thereafter, or sharing the Work or a YouTube link to the Work with the Victims Week National Organizing Committee or Justice Canada employees for the purposes of voting in the Victims Week Student Video Competition Award.

I understand that my participation in the Student Video Competition Award is voluntary and there will be no royalty fees paid to me by Justice Canada for the rights to use my/our Work in the manner described herein. The refusal to participate will in no way negatively impact any future dealings I may have with Justice Canada.

I release Justice Canada, its agents, officers, employees, contractors, successors and assigns, from any claims, liability, damages, action or causes of action, arising from or relating to the use of the submitted Work.

I consent to the inclusion of my video entry in a YouTube playlist created by Justice Canada and to the disclosure of my video entry and/or to the playlist, which will include my video entry, to the Victims Week National Organizing Committee and Justice Canada employees directly involved in the Victims Week initiative.

This agreement will be governed and interpreted by the laws in force in the province of Ontario, as well as any applicable federal legislation.

Participant 1

Participant 2 (if applicable)

Participant 3 (if applicable)

Participant 4 (if applicable)