2016 Media Waiver

WEBSITE AND MEDIA RELEASE FORM

I hereby consent to and authorize the use and reproduction by the Canadian Kettlebell Sport Nationals (CKA)  &/or IRON-BELL FITNESS ( Victoria, BC) of any and all photographs, videos recordings or audio recordings taken of

 _________________________________________

(Name of participant)

for use on websites, in print and other media for purposes of promotions, illustration, advertising or publication without compensation.  All recorded media, prints, and created media from the content shall constitute the property of the Canadian Kettlebell Sport Nationals (CKA) &/or IRON-BELL FITNESS (Victoria, BC).

____________________________    _______________

(Participant Signature)                                             (Date)

 

____________________________    ______________

(Address)                                                                      (City)

_________                  ___________          ____________

(Province)                        (Postal Code)                  (Phone #)

I hereby certify that I am the Parent or Legal Guardian of

__________________________________________

 (Participant under age of 18)

and I do give my consent on his/her behalf

______________________________              ________

(Signature of Parent or Guardian)                               (Date)