VIDEOTAPE CONSENT FORM

I understand that as part of my admission to the Scientific Karate Inc. (SKI) Dr. Stricevic’s Karate Instructor Program (Dr.S’sKIP) [thereafter referred to as Dr.S’sKIP], I need to produce at my expense a 20 minute Introductory Videotape (thereafter referred to as 20mIV) and submit the tape to Dr.S’sKIP. I understand that any injury or any other type of problem that may result prior, during, or after the production of the tape is solely my responsibility and that I absolve and hold harmless SKI and Dr.S’sKIP and all those that work with them of any liability directly or indirectly related to production of this tape.
I further understand that as part of the requirements for graduation I need to produce a 50 minute Final Project Instructional Videotape (thereafter referred to as 50mFPV) at my expense and submit the tape to the Dr.S’sKIP prior to my graduation. I understand that any injury or any other type of problems that is related to the tape and may occur prior, during or after the production of the tape is solely my responsibility and that I absolve and hold harmless SKI and Dr.S’sKIP and all those that work with them of any liability directly or indirectly related to production of 50mFPV.
I further understand that both videotapes may be used by SKI and/or Dr.S’sKIP as part of teaching material, seminars, books in paper and/or electronic format as well as publication in magazines and brochures and I consent to that without any reservation.
I further understand that it is my responsibility to obtain singed clearance forms from athletes or their parent(s) and/or legal guardian(s) in case of a minor to videotape them for Dr.S’sKIP purposes.
Finally, I am voluntarily giving these tapes (20mIV and 50mFRIV) to SKI and Dr.S’sKIP
with the understanding that these tapes and their contents are the sole property of SKI and Dr.S’sKIP and I consent to that without any remuneration in any form.

__________________________ ________________________ __________
Name of Instructor (Print) (Sign) Date

_________________________ _________________________ __________
Name of Witness (Print) (Sign) Date