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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.

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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

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 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
First Participant's Name

First Name*

Last Name*

Phone*
First Participant's 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*
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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