Winner's Form — Early Bird Prize

You’re receiving this link because you recently won an early bird prize as part of 50/50 raffle benefitting the Montreal Canadiens Children’s Foundation. Details of your prize have already been communicated to you by telephone or email.

To receive your prize, you must complete the form below.

For any questions, please contact us at [email protected] and we will get back to you as soon as possible.

Name(Required)

First Last

Email(Required)

Phone number(Required)

Postal address(Required)

Street number and name Apt. City Province Postal code

Date of birth(Required)

Preferred language of communication

Liability release

Please read the following conditions and check each box to confirm that you accept the following statements:(Required)

I understand that I must accept the prize as awarded and it cannot be exchanged or transferred. In return for the prize, I consent that my name, city of residence, photograph, image and/or voice be used, if necessary, at the sole discretion of the Montreal Canadiens Children’s Foundation, the Montreal Canadiens, the Groupe CH and all its entities in all publicity related to this raffle, without any form of compensation or remuneration.

I understand that in order to claim my prize, I must have provided and completed all the required information within fourteen (14) business days. I understand that by failing to provide all the necessary information within the set time limits, a new winning number will be drawn the next business day.

I commit myself to releasing any responsibility to the Montreal Canadiens Children’s Foundation, the Montreal Canadiens, the Groupe CH and their respective advertising and promotional agencies, in the case of complaints, claims, damage, legal proceedings or unspecified reasons for legal proceedings being able to be pled against them or one of them, now and thereafter, by myself, my heirs, the will executors or administrators relative with the 50/50 program.

By checking the following boxes, I hereby declare that:(Required)

I have read, understood, have adhered, and will continue to adhere to all the rules of the said draw and agreed to the above mentioned conditions;

I am not an employee, agent or representative of Montreal Canadiens Children’s Foundation nor do I reside with one of those persons;

This declaration is a veracious and precise statement of facts mentioned.

Please indicate your full name and the date on which you completed this declaration.(Required)

Date(Required)

Pieces of identification (ID)

Please upload photos or scans of two (2) valid pieces of ID, showing your name and date of birth, with at least one (1) that includes a photo.(Required)

Drop files here or

Max. file size: 300 MB.

For example, you can submit a copy of your passport, driver's license, health insurance card, birth certificate, Secure Certificate of Indian Status (SCIS), or any other official document issued by a federal or provincial authority, or a territorial or state government, to confirm your identity.