Media Waiver (optional)

I hereby acknowledge the entities below, to use any photograph(s), video recording(s), and or audio recording(s), therefrom, and any other reproductions or adaptations therefrom, either complete, or in part, alone or in conjunction with any wording and/or drawings for all uses, including publicity and/or merchandising, and/or editorial purposes.

·       Break the Boundary Inc.

·       Department of Local Government, Sports and Cultural Industries (Western Australia)

·       City of Kalamunda.

I understand that I do not have any interest in the copyright to the photograph(s), video recording(s), and or audio recording(s) nor shall I receive any payment.