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Media Release:

I hereby grant permission to the Klepper Training Academy and its affiliates to use photographs and videos of myself for promotional and training purposes on social media platforms and other training materials if and/or when these visual materials are taken.

I understand that these materials may be used in various capacities, including but not limited to:

  • Social media posts
  • Training materials
  • Website content
  • Brochures and promotional materials

I acknowledge that my participation in these photographs and videos is voluntary and that I will not receive any financial compensation for their use.

I also understand that once these materials are posted on social media or other platforms, they may be shared and distributed by other users and may be subject to comments and interactions from the public.

I hereby release and discharge The Klepper Training Academy and its affiliates from any and all claims, demands, or causes of action that I may have against them arising out of or in connection with the use of these photographs and videos.

Medical History Questionnaire: 

You must be truthful in your telling of any reasonable pertinent medical ailments to enable the lead trainers conducting activities to make a judgement call on the suitability of your participation, as well as to ensure medications can be issued in the correct dosage (if required). Any lie or omission of pertinent medical information may result in INJURY or DEATH if the first aid practitioners are not able to render adequate assistance.

Please select who will be participating...
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Media Release
Do you authorise Klepper Training Academy to utilise media (including Photos and Videos) for the purposes articulated above)?*
Yes
No
Medical History Questionaire

Duty of Care Statement – Klepper Training Academy

Urge Training Pty Ltd (T/a Klepper Training Academy (RTO ID 45075)) is committed to ensuring the safety, health, and wellbeing of all participants and staff involved in its training activities and programs. The Academy undertakes comprehensive risk assessments, maintains rigorous safety standards, and employs appropriately qualified personnel to minimise risks and manage incidents effectively.

Participants are required to disclose any pre-existing medical conditions, injuries, or other factors that may affect their ability to safely participate in training activities. By signing this waiver, participants acknowledge their responsibility to inform Klepper Training Academy of such conditions and to actively follow all provided safety instructions and guidance.

Klepper Training Academy is dedicated to providing a safe training environment but recognises that some inherent risks may exist in practical training scenarios. Participants accept these inherent risks and agree to adhere strictly to safety protocols at all times.

Should any concerns arise regarding health, safety, or welfare, participants are encouraged to immediately notify their instructor or training supervisor.

By participating in training activities with Klepper Training Academy, you acknowledge understanding and acceptance of this Duty of Care Statement.

If you answer yes to any of the following, please expand in the section below:

Do you suffer from Asthma?*
No
Yes
If yes, please provide details
Do you suffer from Alergies?*
No
Yes
If yes, please provide details
Other Medical Conditions*
No
Yes
If yes, please provide details
Do you currently suffer from any heart injuries, ailments or issues?*
No
Yes
If yes, please provide details
Do you take any regular medications (that is, a specific dosage required at set intervals e.g. a Daily heart medication, or antibiotic, etc).*
No
Yes

If yes to the above, please specify in the box below the medication you are required to take, the dosage and the frequency

If yes, please provide details

Privacy Collection Notice

This Privacy Collection Notice describes how Urge Training Pty Ltd t/as Klepper Training Academy (ABN 63 611 960 724) (we, us or our) collects and handles your personal and sensitive information when you complete this Medical History Questionnaire. We collect this information from you, and where you are a minor, from your parent or guardian, so that our trainers can assess your suitability to safely participate in our activities, determine appropriate first aid or medical response if required, and for related purposes set out in our Privacy Policy, available on our website (or on request).

By completing and submitting this Medical History Questionnaire, you consent to our collection of your health and medical information for these purposes.

We may disclose this personal information to our personnel, related entities, our waiver and training management service providers, medical or emergency service providers where necessary, and as otherwise set out in our Privacy Policy.

We store personal information in Australia. Where we disclose your personal information to third parties, those third parties may store, transfer or access personal information outside of Australia.

If you do not provide accurate and complete information about your medical history, it may affect our ability to safely assess your suitability to participate in our activities, and may put your health and safety, or the health and safety of others, at risk.

Please see our Privacy Policy for more information about how we collect, store, use and disclose your personal information, including details about overseas disclosure, access, correction, how you can make a privacy-related complaint and our complaint-handling process.

If you have questions about our privacy practices, please contact us by email at: hello@klepper.edu.au. By providing your personal information to us, you agree to the collection, use, storage and disclosure of that information as described in this privacy collection notice.

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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