MARU MARTIAL ARTS
                              500 Virginia Ave. # 1202
                              Towson, MD 21286
                              410-790-115

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                               Media Waiver

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I hereby authorize Maru Martial Arts to take photograph, video graph or otherwise record my image, sound, and likeness while I am participating in any activity sponsored by or connected with Maru Martial Arts. I agree that such recordings may be published by Maru Martial Arts to third parties in advertisements, books, or instructional materials. I hereby waive any and all right to any compensation in connection with Maru Martial Arts's publication of such recordings, even if Maru Martial Arts derives a profit from the publication.

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Signature of Student

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Printed Name

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Date

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Witness Signature

_______________________________________________ ______ Date _____________
Signature of Maru Martial Arts Representative

For students under 18 years of age

Acknowledgment and Agreement of Legal Guardian, if applicable:

Signature of Legal guardian, ____________________________________________________________________

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Printed Name

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Date