Complete this form for all ON CAMPUS Student Film Production Shoots at least 21 DAYS in advance of the shoot. THIS FORM MUST BE COMPLETED BY A STUDENT WHO IS RECEIVING ACADEMIC CREDIT for the course to which the project satisfies a requirement.
STUDENT/PARTICIPANT INFORMATION:






RELEASE WAIVERS FOR MINORS:
A Release Waiver must be signed by a parent/guardian PRIOR TO any minor participating in the shoot. You must use the template form located on the Risk Management Website at: https://www.ithaca.edu/riskmanagement/docs/waiver18_minors/. The signed release waiver must be retained by the Dean's Office. Transportation of the minor to and from the shoot is the responsibility of the parent/guardian. The parent/guardian must remain on location with their minor during the shoot at all times.
NYS REQUIREMENTS FOR MINORS IN FILM SHOOTS/PRODUCTIONS:
No minor (less than 18 years of age) may participate or be employed in film shoot and/or production without first obtaining a valid Child Performer Permit, issued by the Commissioner for the New York State Department of Labor.
• A minor may obtain a 15-day Temporary Child Performer Permit only once.
• A minor must obtain a 12-month Child Performer Permit if they have ever previously had the Temporary Child Performer Permit.
• The Temporary Child Performer Permit can be found and completed, at no charge, on the NYS Department of Labor website, at: https://www.labor.ny.gov/secure/ChildPerformer/welcome.html
• Minors may not be employed for compensation for student productions.
PLEASE NOTE: ACTION AND PROPS OF CONCERN ARE SUBJECT TO REVIEW AND APPROVAL BY THE DEAN'S OFFICE.
PLEASE NOTE: SCENES SIMULATING VIOLENT ACTIONS AND/OR INVOLVING CHOREOGRAPHED FIGHT SCENES, WEAPONRY, ETC., THOSE PORTIONS OF THE SCRIPT MUST BE REVIEWED AND APPROVED BY YOUR INSTRUCTOR PRIOR TO FILMING.

















LOCATION INFORMATION - FIELDS ARE PROVIDED FOR UP TO THREE ON-CAMPUS LOCATIONS.
In the areas below please provide the EXACT Campus Location (ie: Parking Lot G, Campus Center 2nd floor, Classroom 309, Freeman Field, etc.) If more than one campus location will be used please list each campus location separately below. BE ADVISED: there are some buildings/areas on campus that CANNOT be used for film shoots/productions; you will be advised if an alternate location must be found. Generally the following buildings are NOT available for film shoots: Health Center, Public Safety Office, Vehicle Garages, Observatory, Muller Chapel, most of PRW Center, science labs, the pool and arena areas of the A & E Center, roof tops and near/on water.
There are many events and activities happening on campus, for this reason it is important you contact and/or reserve space through the appropriate mechanism; for example: Campus Center and Events Services (CCES), 25 Live, Athletics (field usage), Jake Brenner (Natural Lands), Parking Services, etc. This allows for coordination of events/spaces.
Note: If you only have one location please complete the required information for LOCATION #1 and proceed to the Assumption of Risk and Responsibility section.
LOCATION #1


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LOCATION #2


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LOCATION #3


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ASSUMPTION OF RISK AND RESPONSIBILITY: I understand that I will be responsible for any and all damages or losses to College-owned property while in my care, custody, and control, due to my own negligent acts or negligent acts of others who participate in my shoot; that I am fully responsible for any and all expenses, losses or damages to equipment from an outside rental company; that I am responsible for any and all injuries and third-party property damages or losses resulting from my own negligent acts or the negligent acts of others who participate in my shoot, and that I must report any and all injuries and/or property damages immediately to the Office of Public Safety at 607-274-3333.

I hereby affirm that I have provided a complete and accurate script for this film shoot/production to my instructor (for the course to which the project satisfies a requirement), and obtained their approval. I further understand that, before I begin the on-campus shoot/production, I must first obtain approval from the Dean’s Office in response to this form.

I hereby verify that all information is true and acknowledge that any false information provided is the equivalent of Academic Dishonesty, for which I could be subject to judicial referral and cancellation of all Ithaca College owned equipment check-out.
I agree, and it is my intent, to sign this document and affirmation by clicking the box below marked "I AGREE". By electronically submitting this document I understand that my signing and submitting this document in this fashion is the legal equivalent of having placed my handwritten signature on the submitted document and this affirmation. I understand and agree that by electronically signing and submitting this document in this fashion I am attesting to the truth of the information contained therein.

 
After clicking on the submit button you will need to scroll to the top of the page and you should see a confirmation message that your form was submitted.