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To accept your prize, please complete the steps below.
Affidavit of Eligibility, Publicity Release and Liability Waiver
This Affidavit of Eligibility, Publicity Release and Liability Waiver (the “Agreement”) must be read and signed by persons (“Winners”) who are awarded a prize (“Prize”) in sweepstakes and contests sponsored by Sharecare, Inc., (“Sponsor”) or any of its affiliates or subsidiaries (the sweepstakes or contest in which the undersigned has been awarded a Prize is hereinafter referred to as the “Promotion”). If Winner is a legal minor, Winner’s parent or legal guardian must also read and sign this Agreement. The Promotion Winner is referred to below as “I” or “me.” In consideration of the awarding of a Prize to me, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I (and if I am a minor, my parent or legal guardian) hereby agree as follows: I represent that I am eligible to receive the Prize awarded to me in the Promotion. I alone am obligated to pay any taxes (to the federal, state or local government) on the value of the prize that may be awarded pursuant to the Promotion. I acknowledge that Sponsor will require my Social Security Number if the prize being awarded is valued at $600.00 or greater in order that sponsor may comply with federal law. I give permission to Sponsor and its subsidiaries and affiliates to, without additional compensation to me, use, adapt, reproduce, distribute, display and publicly perform my name, photograph, likeness, statements, voice, voice likeness and city and state address for advertising, publicity and promotional purposes. I understand that any material I submitted and/or entered into the Promotion is the sole property of Sponsor and may be used by Sponsor for any purpose. I represent that I independently created the material I submitted to Sponsor. I assign and convey to Sponsor all right, title and interest in and to the submitted material(s) and all copyright, trademark and other intellectual property rights in the submitted material(s), and agree to take any actions (including execution of documents) reasonably requested by Sponsor to effect, perfect or evidence the foregoing assignment. I ACKNOWLEDGE THAT ANY PRIZE IS PROVIDED “AS IS” AND ACCEPTANCE, PARTICIPATION IN AND/OR USE OF ANY PRIZE IS SOLELY AT MY OWN RISK. THEREFORE, I HEREBY RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS SPONSOR AND ITS AFFILIATES AND SUBSIDIARIES FROM ANY AND ALL CLAIMS I MAY NOW OR HEREAFTER HAVE WITH RESPECT TO ANY HARM THAT MAY BE SUFFERED BY ME OR ANY THIRD PARTY AS A RESULT OF THE PROMOTION, ANY USE BY SPONSOR OF MY NAME, VISUAL LIKENESS OR BIOGRAPHICAL DATA, OR IN CONNECTION WITH MY ACCEPTANCE, PARTICIPATION IN, USE OF AND/OR INABILITY TO USE ANY PRIZE AWARDED TO ME, EVEN IF SUCH HARM IS CAUSED SOLELY BY THE RECKLESSNESS, NEGLIGENCE OR FAULT OF ONE OR MORE RELEASED PARTIES (COLLECTIVELY, THE “RELEASED CLAIMS”). IF I AM A MINOR, MY PARENT OR LEGAL GUARDIAN, BY THEIR SIGNATURE BELOW, HEREBY AGREES TO INDEMNIFY AND HOLD HARMLESS SPONSOR AND ALL OTHER RELEASED PARTIES FROM AND AGAINST ANY AND ALL CLAIMS, COSTS, LOSSES, DAMAGES AND EXPENSES (INCLUDING REASONABLE ATTORNEYS’ FEES) INCURRED BY SPONSOR AND ANY OTHER RELEASED PARTY ARISING OUT OF OR IN CONNECTION WITH ANY RELEASED CLAIMS. I SPECIFICALLY UNDERSTAND AND AGREE THAT THIS RELEASE WILL PREVENT ME AND MY SUCCESSORS FROM BRINGING A LAWSUIT, CLAIM OR OTHER ACTION AGAINST SPONSOR OR ANY OTHER RELEASED PARTY AND FROM RECOVERING ANY MONEY DAMAGES OR OTHER LEGAL RELIEF FROM SPONSOR OR ANY OTHER RELEASED PARTY IN CONNECTION WITH ANY OF THE CLAIMS RELEASED ABOVE. If any provision of this Agreement is found to be unenforceable in any respect by a court, it is my intention and understanding that this Agreement shall nonetheless be enforced to the maximum extent to which it is found by the court to be legally enforceable. This agreement shall be governed by the laws of the State of Georgia, without reference to its choice of law rules. I consent to the exclusive jurisdiction and venue of the federal and state courts located at Fulton County, Georgia with respect to any claim or suit arising out of or in connection with this Agreement, the Promotion, any delivery, misdelivery or nondelivery of any Prize or my acceptance, participation in, use of, or inability to use any Prize, and agree not to commence or prosecute any such claim or suit other than in the aforementioned courts. I acknowledge and agree that my consent to the terms set forth above is material inducement for Sponsor to award a Prize to me and Sponsor would not do so in the absence of my consent as evidenced by my signature below. I agree to return or have returned immediately, upon demand to Sponsor, any prize or the value of said prize which has been awarded me, if any statement made by me in this Agreement is, or proves to be, false. This Agreement constitutes the entire agreement between myself and Sponsor with respect to the matters described herein, and supersedes any and all other agreements and communications, oral or written, between myself and Sponsor or any other Released Party with respect to such matters. This Agreement may not be amended or supplemented except by a writing signed by Sponsor specifically referencing this Agreement.
We need the following information to award your prize.
Contest / Sweepstakes / Promotion Name
Please type the name of the contest, sweepstakes, or other promotion identified in your prize notification.
State / Province / Region
ZIP / Postal Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Congo, Democratic Republic of the
Congo, Republic of the
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
Virgin Islands, British
Virgin Islands, U.S.
If your prize is $600 or more, please attach your W9 IRS Tax Form.
This tax form is available on the
Please upload your files (pdf)
Drop files here or
Accepted file types: pdf.
THIS IS A LIABILITY RELEASE
By submitting my information, I represent and warrant that the information is accurate and that I have authority to bind the individual/entity identified in this submission.