“On-Air” Release

Student / Participant name *

First Name

Last Name

On-Air Release *

For valuable consideration, the receipt and sufficiency of which are hereby acknowledged, and intending to be legally bound, I hereby give Level 3 Martial Arts Performance (L3MAP), related entities, it’s representatives and assignees, employees, or any person, persons, corporation, or corporations acting under it’s permission or authority, or any person, persons, corporation, or corporations for whom it might be acting, the right and permission to publish, reproduce, distribute and/or otherwise use any still or moving photographic or sound recording of me or my minor child in whole or in part (the “Performance”), including but not limited to any statement or endorsement (including any letter or photograph and/or my first and last name), or any other portions thereof (the “Testimonial”), made by me or my minor child regarding or related to the product known as “martial arts promotion” (working name, final name is subject to change) (the “product”) in such manner, for such purposes and with such frequency as it shall determine in its sole discretion without further compensation or consideration to me and without further authorization by me. I further acknowledge that the Performance and/or Testimonial shall be the sole property of L3MAP. I also confirm (1) that any statement or endorsements made by me in the Performance and/or Testimonial are factually accurate and represent my honest opinions, findings, beliefs, or experiences, (2) that I was not compensated in exchange for my endorsement, and (3) that there exists no material connection between myself and L3MAP. I hereby waive all rights of inspection or approval with regard to any recording, filming, reproduction, proposed printed, audio or video publication and/or other use, including social media, of the Performance and/or Testimonial. I also hereby release, discharge and agree to hold harmless L3MAP, it’s representatives, assignees, employees or any person, persons, corporation, or corporations for whom it might be acting, including any person, persons, corporation, or corporations distributing or disseminating advertising for “Martial Arts Promotion” (working name, final name is subject to change) (the “Product”) from and against any and all liability resulting from its use of the Performance and/or Testimonial or related to the use of the product. I hereby warrant that I am over eighteen years of age, and competent to contract in my own name or on behalf of the above listed minor. I have read this release and affidavit before affixing my signature below and warrant that I fully understand the contents thereof.

Responsible / Permitting party name *

First Name

Last Name

Responsible party phone *

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