Under 18 media Release Form

1

I hereby authorise Progressive Training (WA) Pty Ltd to publish the photographs or video taken of me, for use in printed publications, videos, social media (eg Facebook) and on authorised websites.

Upon agreeing to the release of your information, please be aware of the following:

Your address or other contact details WILL NOT be included with your picture when publishing on the Web or any printed publications.

You acknowledge that you will receive no financial compensation.

You release Progressive Training (WA) Pty Ltd and their employees/contractors from liability for any claims by the undersigned or any third party in connection with their participation.

2

Date:* This field is required.

Date

3

Under 18 Student Name:* This field is required.

First Name

Last Name

4

Under 18 Student Signature:* This field is required.

5

Guardian/Parents Name:* This field is required.

First Name

Last Name

6

Guardian/Parents Phone Number:* This field is required.

7

Photo IDTake a photo of the Students ID

8

Guardian/Parents Signature:* This field is required.